ADVANCED SPINE AND PAIN LLC NPI 1366048860

NPI Information

  • NPI: 1366048860
  • Provider Name: ADVANCED SPINE AND PAIN LLC
  • Classification: Pain Medicine - 208VP0014X
  • Specialization: Interventional Pain Medicine
  • Entity Type: Organization
  • CLIA Number: 03D2225610
  • Address: 13555 W MCDOWELL RD STE 207
    GOODYEAR, AZ
    ZIP 85395
  • Phone: (480) 573-0130

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NPI Details

ADVANCED SPINE AND PAIN LLC is an interventional pain medicine pain medicine in Goodyear, AZ. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. ADVANCED SPINE AND PAIN LLC NPI is 1366048860. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

13555 W MCDOWELL RD STE 207
GOODYEAR, AZ
ZIP 85395-628
Phone: (480) 573-0130

The provider's authorized official is Jarrett Michael Leathem .
The authorized official title is Owner and has the following contact phone number (480) 573-0130.

The CLIA number assigned to this NPI record is 03D2225610 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/9/2020 and was last updated on 1/20/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207L00000XAnesthesiologyNo
22081P2900XPhysical Medicine & RehabilitationPain MedicineNo
3208VP0000XPain MedicinePain MedicineNo
4363A00000XPhysician AssistantNo
5363L00000XNurse PractitionerNo
6208VP0014XPain MedicineInterventional Pain MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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