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General NPI Number Information
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NPI Number | 1063229797
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Entity Type | Organization
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Legal Business Name | RENEW HEALTH OF ARIZONA LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 426 E SOUTHERN AVE STE 101
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City | TEMPE
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State | AZ
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Zip | 85282-5215
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Country | US
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Telephone | 480-681-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 4420 N SONOMA RANCH BLVD STE B
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City | LAS CRUCES
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State | NM
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Zip | 88011-7342
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Country | US
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Telephone | 575-532-1334
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LINDSAY TIGHE
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Credential |
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Telephone | 404-484-1459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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