Provider Demographics
NPI:1760189310
Name:AZSDS LLC
Entity Type:Organization
Organization Name:AZSDS LLC
Other - Org Name:AZ SPINE DISC AND SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BREURE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-265-5641
Mailing Address - Street 1:924 N SWEETWATER BAY DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4983
Mailing Address - Country:US
Mailing Address - Phone:480-265-5643
Mailing Address - Fax:
Practice Address - Street 1:4960 W RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-6219
Practice Address - Country:US
Practice Address - Phone:480-759-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service