Healthcare Provider Details

I. General information

NPI: 1063229797
Provider Name (Legal Business Name): RENEW HEALTH OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 E SOUTHERN AVE STE 101
TEMPE AZ
85282-5215
US

IV. Provider business mailing address

4420 N SONOMA RANCH BLVD STE B
LAS CRUCES NM
88011-7342
US

V. Phone/Fax

Practice location:
  • Phone: 480-681-7979
  • Fax:
Mailing address:
  • Phone: 575-532-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY TIGHE
Title or Position: PRESIDENT
Credential:
Phone: 404-484-1459