Provider Demographics
NPI:1811940554
Name:DEER VALLEY SPINE CENTER, LLC
Entity type:Organization
Organization Name:DEER VALLEY SPINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:AMRANI
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:602-588-2225
Mailing Address - Street 1:2735 W UNION HILLS DR
Mailing Address - Street 2:
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:
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:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 35194261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
E72610Medicare UPIN