MEDICARE: NOVASPINE PAIN INSTITUTE PLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	42990	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841600921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVASPINE PAIN INSTITUTE PLC

Provider Business Mailing Address
First Line	:	13203 N 103RD AVE STE H5
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3032
Country	:	US
Telephone Number	:	623-777-4747
Fax Number	:	623-777-4748

Provider Business Practice Location Address
First Line	:	13203 N 103RD AVE STE H5
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3032
Country	:	US
Telephone Number	:	623-777-4747
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	HEATHER SPENCER
Credential	:
Telephone Number	:	623-777-4747

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	09/19/2019

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