Healthcare Provider Details

I. General information

NPI: 1720174113
Provider Name (Legal Business Name): SOUTHWEST SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 E SHEA BLVD SUITE 114
SCOTTSDALE AZ
85260-6411
US

IV. Provider business mailing address

7425 E SHEA BLVD SUITE 114
SCOTTSDALE AZ
85260-6411
US

V. Phone/Fax

Practice location:
  • Phone: 480-315-0900
  • Fax: 480-315-1300
Mailing address:
  • Phone: 480-315-0900
  • Fax: 480-315-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRY E MCLEAN
Title or Position: OWNER
Credential: MD
Phone: 480-315-0900