Provider Demographics
NPI:1083801054
Name:ARIZONA NEUROSURGERY AND SPINE SPECIALISTS, PC
Entity Type:Organization
Organization Name:ARIZONA NEUROSURGERY AND SPINE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-254-3151
Mailing Address - Street 1:1331 N 7TH ST
Mailing Address - Street 2:275
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2754
Mailing Address - Country:US
Mailing Address - Phone:602-254-3151
Mailing Address - Fax:
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:275
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:602-254-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ118552OtherMEDICARE PTAN: