Healthcare Provider Details

I. General information

NPI: 1609168442
Provider Name (Legal Business Name): ARIZONA SPINE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 E CONFERENCE DR STE 111
TEMPE AZ
85284-2604
US

IV. Provider business mailing address

PO BOX 132618
THE WOODLANDS TX
77393-2618
US

V. Phone/Fax

Practice location:
  • Phone: 480-491-5505
  • Fax: 480-839-2121
Mailing address:
  • Phone: 713-774-5462
  • Fax: 713-774-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number42600
License Number StateAZ

VIII. Authorized Official

Name: MR. THOMAS NGUYEN
Title or Position: BILLING MANAGER
Credential:
Phone: 713-774-5462