Healthcare Provider Details

I. General information

NPI: 1134374440
Provider Name (Legal Business Name): LASER SPINE SURGERY CENTER OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 E. RAINTREE DRIVE SUITE 165
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

5332 AVION PARK DRIVE
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 480-568-6868
  • Fax: 484-253-1790
Mailing address:
  • Phone: 813-682-2944
  • Fax: 484-253-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W PERRY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 813-289-9613