Provider Demographics
NPI:1336509520
Name:ARIZONA SPINE AND PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:ARIZONA SPINE AND PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-795-8700
Mailing Address - Street 1:20280 N 59TH AVE
Mailing Address - Street 2:STE 115-617
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6850
Mailing Address - Country:US
Mailing Address - Phone:602-795-8700
Mailing Address - Fax:602-795-8701
Practice Address - Street 1:1760 E FLORENCE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4765
Practice Address - Country:US
Practice Address - Phone:602-795-8700
Practice Address - Fax:602-795-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ947192Medicaid
AZZ172895OtherMEDICARE PTAN