Provider Demographics
NPI:1386409746
Name:NOVASPINE PAIN INSTITUTE, PLC
Entity type:Organization
Organization Name:NOVASPINE PAIN INSTITUTE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-777-4747
Mailing Address - Street 1:PO BOX 5068
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85376-5068
Mailing Address - Country:US
Mailing Address - Phone:623-777-4747
Mailing Address - Fax:
Practice Address - Street 1:13203 N 103RD AVE STE H5
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3032
Practice Address - Country:US
Practice Address - Phone:623-777-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVASPINE PAIN INSTITUTE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ166942OtherGROUP MEDICARE