Provider Demographics
NPI:1710470802
Name:AZ SPORTS AND SPINE CENTER , LLC
Entity Type:Organization
Organization Name:AZ SPORTS AND SPINE CENTER , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-481-7369
Mailing Address - Street 1:3717 SOUTH HIGLEY ROAD
Mailing Address - Street 2:SUITE 114 PMB 298
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297
Mailing Address - Country:US
Mailing Address - Phone:602-481-7369
Mailing Address - Fax:480-527-1586
Practice Address - Street 1:604 W WARNER RD STE A
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2900
Practice Address - Country:US
Practice Address - Phone:602-481-7369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical