Provider Demographics
NPI:1194878736
Name:DESERT INSTITUTE FOR SPINE DISORDERS, PC
Entity type:Organization
Organization Name:DESERT INSTITUTE FOR SPINE DISORDERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:DH
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-656-4048
Mailing Address - Street 1:8573 E PRINCESS DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7819
Mailing Address - Country:US
Mailing Address - Phone:480-656-4048
Mailing Address - Fax:480-247-6146
Practice Address - Street 1:8573 E PRINCESS DR
Practice Address - Street 2:SUITE 221
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7819
Practice Address - Country:US
Practice Address - Phone:480-656-4048
Practice Address - Fax:480-247-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ596398Medicaid
AZ596398Medicaid
AZ6067720001Medicare NSC
AZ110112Medicare PIN