Provider Demographics
NPI:1861861395
Name:ARIZONA SPINE SPECIALIST PLLC
Entity Type:Organization
Organization Name:ARIZONA SPINE SPECIALIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-396-3936
Mailing Address - Street 1:PO BOX 674074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4074
Mailing Address - Country:US
Mailing Address - Phone:214-396-3936
Mailing Address - Fax:214-378-4664
Practice Address - Street 1:1635 E MYRTLE AVE STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5514
Practice Address - Country:US
Practice Address - Phone:214-396-3936
Practice Address - Fax:214-378-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty