Provider Demographics
NPI:1710068804
Name:ARIZONA SPINE CARE ALLIANCE PC
Entity Type:Organization
Organization Name:ARIZONA SPINE CARE ALLIANCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:WINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-831-2225
Mailing Address - Street 1:7119 E SHEA BLVD
Mailing Address - Street 2:SUITE 109-528
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6107
Mailing Address - Country:US
Mailing Address - Phone:480-831-2225
Mailing Address - Fax:480-831-0535
Practice Address - Street 1:8124 E CACTUS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-831-2225
Practice Address - Fax:480-831-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ134883Medicaid
AZAZ0350900OtherBLUE CROSS
AZZ62348Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
AZAZ0350900OtherBLUE CROSS
AZZ62347Medicare ID - Type UnspecifiedGROUP NUMBER