Provider Demographics
NPI:1871667014
Name:ARIZONA CENTER FOR NEUROSURGERY, LTD
Entity Type:Organization
Organization Name:ARIZONA CENTER FOR NEUROSURGERY, LTD
Other - Org Name:PHOENIX SPINE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-385-0430
Mailing Address - Street 1:140 N LITCHFIELD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1226
Mailing Address - Country:US
Mailing Address - Phone:602-256-2525
Mailing Address - Fax:602-256-0795
Practice Address - Street 1:140 N LITCHFIELD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1277
Practice Address - Country:US
Practice Address - Phone:602-256-2525
Practice Address - Fax:602-256-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28519207T00000X
AZ35838208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ987125Medicaid
AZ5489300001Medicare NSC
AZ987125Medicaid
AZZ75138Medicare ID - Type UnspecifiedGROUP