Healthcare Provider Details

I. General information

NPI: 1538656301
Provider Name (Legal Business Name): PHOENIX SPINE SCOTTSDALE ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 N 91ST ST STE C100
SCOTTSDALE AZ
85258-5054
US

IV. Provider business mailing address

2525 E ARIZONA BILTMORE CIR STE D142
PHOENIX AZ
85016-2147
US

V. Phone/Fax

Practice location:
  • Phone: 602-256-2525
  • Fax:
Mailing address:
  • Phone: 602-256-2525
  • Fax: 602-256-0795

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: MS. DEB SWATON
Title or Position: DIRECTOR OF NURSING
Credential:
Phone: 602-256-2525