Provider Demographics
NPI:1316281967
Name:THE CORE INSTITUTE SPINE CENTER GILBERT
Entity type:Organization
Organization Name:THE CORE INSTITUTE SPINE CENTER GILBERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-474-3427
Mailing Address - Street 1:2680 S VAL VISTA DR
Mailing Address - Street 2:BUILDING 9, SUITE 146
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2152
Mailing Address - Country:US
Mailing Address - Phone:623-537-5600
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:2680 S VAL VISTA DR
Practice Address - Street 2:BUILDING 9, SUITE 146
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2152
Practice Address - Country:US
Practice Address - Phone:623-537-5600
Practice Address - Fax:866-939-2673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CORE INSTITUT E
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-20
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341246Medicaid
AZ341246Medicaid