Healthcare Provider Details

I. General information

NPI: 1881048650
Provider Name (Legal Business Name): ARIZONA BRAIN AND SPINE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 N SCOTTSDALE RD STE 240
SCOTTSDALE AZ
85254-5111
US

IV. Provider business mailing address

11000 N SCOTTSDALE RD STE 240
SCOTTSDALE AZ
85254-5111
US

V. Phone/Fax

Practice location:
  • Phone: 602-396-7363
  • Fax: 602-266-2927
Mailing address:
  • Phone: 602-396-7363
  • Fax: 602-266-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1120808
License Number StateAZ

VIII. Authorized Official

Name: MRS. AMBER N HENRY
Title or Position: PRACTICE ADMINISTRATOR
Credential: FACMPE
Phone: 602-396-7363