Provider Demographics
NPI:1326071010
Name:ADVANCED BACK AND NECK CARE OF OCOTILLO, PC
Entity Type:Organization
Organization Name:ADVANCED BACK AND NECK CARE OF OCOTILLO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GULDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-814-7115
Mailing Address - Street 1:1055 W QUEEN CREEK RD
Mailing Address - Street 2:#3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-8134
Mailing Address - Country:US
Mailing Address - Phone:480-814-7115
Mailing Address - Fax:480-814-7792
Practice Address - Street 1:1055 W QUEEN CREEK RD
Practice Address - Street 2:#3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-8134
Practice Address - Country:US
Practice Address - Phone:480-814-7115
Practice Address - Fax:480-814-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDD7117Medicare Oscar/Certification
AZZ70637Medicare PIN
AZ00033731OtherBANNER HEALTH