Basic Information
| Provider Information | |||||||||
| NPI: | 1083801054 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA NEUROSURGERY AND SPINE SPECIALISTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 N 7TH ST | ||||||||
| Address2: | 275 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022543151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1331 N 7TH ST | ||||||||
| Address2: | 275 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022543151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2007 | ||||||||
| LastUpdateDate: | 07/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | WILLIS | ||||||||
| AuthorizedOfficialFirstName: | BYRON | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6022543151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | Z118552 | 01 | AZ | MEDICARE PTAN: | OTHER |