Practice Information |
|
Organization Legal Name
|
DESERT INSTITUTE FOR SPINE CARE PC
|
|
Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
|
|
Group Practice PAC ID
|
1951347475
|
|
Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
|
|
Number of Group Practice members
|
8
|
|
Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
|
|
Line 1 Street Address
|
1635 E MYRTLE AVE
|
|
Group Practice or individual's line 1 address
|
|
Line 2 Street Address
|
SUITE 400
|
|
Group Practice or individual's line 2 address
|
|
City
|
PHOENIX
|
|
Group Practice or individual's city
|
|
State
|
AZ
|
|
Group Practice or individual's state
|
|
Zip Code
|
850205514
|
|
Group Practice or individual's zip code (9 digits when available)
|
|
Phone Number
|
6029442900
|
|
Phone number is listed only when there is a single phone number available for the practice location address
|
Hospital(s) Affiliation Information |
|
Hospital Affiliation CCN 1
|
030087
|
|
Medicare CCN of hospital where individual professional provides service 1
|
|
Hospital Affiliation LBN 1
|
HONORHEALTH SCOTTSDALE SHEA MEDICAL CENTER
|
|
Legal business name of hospital where individual professional provides service 1
|
|
Hospital Affiliation CCN 2
|
030108
|
|
Medicare CCN of hospital where individual professional provides service 2
|
|
Hospital Affiliation LBN 2
|
THE CORE INSTITUTE SPECIALTY HOSPITAL
|
|
Legal business name of hospital where individual professional provides service 2
|
|
Hospital Affiliation CCN 3
|
030131
|
|
Medicare CCN of hospital where individual professional provides service 3
|
|
Hospital Affiliation LBN 3
|
O.A.S.I.S. HOSPITAL
|
|
Legal business name of hospital where individual professional provides service 3
|
|
Professional Accepts Medicare Assignment
|
Y
|
|
|