MEDICARE: CERVICAL SPINE CENTERS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	41787	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41787	OTHER	AZ	AZ MD LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780062133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERVICAL SPINE CENTERS, PLLC

Provider Business Mailing Address
First Line	:	20280 N 59TH AVE STE 115-345
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6850
Country	:	US
Telephone Number	:	480-656-4220
Fax Number	:	480-656-1554

Provider Business Practice Location Address
First Line	:	20280 N 59TH AVE STE 115-345
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6850
Country	:	US
Telephone Number	:	480-656-4220
Fax Number	:	480-656-1554

Authorized Official
Title or Position	:	CEO
Name	:	JOHN R EHTESHAMI
Credential	:	MD
Telephone Number	:	480-656-4220

Provider Enumeration Date	:	05/18/2015
Last Update Date	:	01/07/2025

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