Healthcare Provider Details

I. General information

NPI: 1356151237
Provider Name (Legal Business Name): SOUTHWEST SPINE & BACK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15571 N REEMS RD BLDG D
SURPRISE AZ
85374-9584
US

IV. Provider business mailing address

15571 N REEMS RD BLDG D
SURPRISE AZ
85374-9584
US

V. Phone/Fax

Practice location:
  • Phone: 623-887-9454
  • Fax: 623-887-9451
Mailing address:
  • Phone: 623-887-9454
  • Fax: 623-887-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SMITH SHARMA
Title or Position: MANAGER
Credential:
Phone: 480-478-5557