Provider Demographics
NPI:1538656301
Name:PHOENIX SPINE SCOTTSDALE ASC, LLC
Entity Type:Organization
Organization Name:PHOENIX SPINE SCOTTSDALE ASC, LLC
Other - Org Name:PHOENIX SPINE CHANDLER ASC, LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:SWATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-256-2525
Mailing Address - Street 1:2525 E ARIZONA BILTMORE CIR STE D142
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2147
Mailing Address - Country:US
Mailing Address - Phone:602-256-2525
Mailing Address - Fax:602-256-0795
Practice Address - Street 1:9700 N 91ST ST STE C100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5054
Practice Address - Country:US
Practice Address - Phone:602-256-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical