Basic Information
| Provider Information | |||||||||
| NPI: | 1871667014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA CENTER FOR NEUROSURGERY, LTD | ||||||||
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| OtherOrganizationName: | PHOENIX SPINE SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 N LITCHFIELD RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853381226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022562525 | ||||||||
| FaxNumber: | 6022560795 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 N LITCHFIELD RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853381277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022562525 | ||||||||
| FaxNumber: | 6022560795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | LIEBERMAN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6023850430 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 35838 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 207T00000X | 28519 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 987125 | 05 | AZ | MEDICAID |