Provider Demographics
NPI:1255528683
Name:DEER VALLEY SPINE CENTER
Entity type:Organization
Organization Name:DEER VALLEY SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:AMRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-588-2225
Mailing Address - Street 1:2735 W UNION HILLS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5033
Mailing Address - Country:US
Mailing Address - Phone:602-588-2225
Mailing Address - Fax:602-588-2226
Practice Address - Street 1:2735 W UNION HILLS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5033
Practice Address - Country:US
Practice Address - Phone:602-588-2225
Practice Address - Fax:602-588-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35194204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109977Medicare PIN
AZE72610Medicare UPIN