Provider Demographics
NPI:1124579628
Name:NOVASPINE PAIN INSTITUTE, PLC
Entity Type:Organization
Organization Name:NOVASPINE PAIN INSTITUTE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-538-1180
Mailing Address - Street 1:13203 N 103RD AVE
Mailing Address - Street 2:SUITE H5
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3028
Mailing Address - Country:US
Mailing Address - Phone:623-777-4747
Mailing Address - Fax:623-777-4748
Practice Address - Street 1:13203 N 103RD AVE
Practice Address - Street 2:SUITE H5
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3028
Practice Address - Country:US
Practice Address - Phone:623-777-4747
Practice Address - Fax:623-777-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42290332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ42990OtherAZ LICENSE