Provider Demographics
NPI:1013219831
Name:AZ INSTITUTE OF SPINE AND SPORTS CARE, LTD
Entity Type:Organization
Organization Name:AZ INSTITUTE OF SPINE AND SPORTS CARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-516-8499
Mailing Address - Street 1:20033 N 19TH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4245
Mailing Address - Country:US
Mailing Address - Phone:623-516-8499
Mailing Address - Fax:623-516-8641
Practice Address - Street 1:20033 N 19TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4245
Practice Address - Country:US
Practice Address - Phone:623-516-8499
Practice Address - Fax:623-516-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22892208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF72363Medicare UPIN