Provider Demographics
NPI:1588846851
Name:PHOENIX SPINE CONSULTANTS PLLC
Entity type:Organization
Organization Name:PHOENIX SPINE CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BEGHIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:623-582-2010
Mailing Address - Street 1:19841 N 27TH AVE STE 300A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4012
Mailing Address - Country:US
Mailing Address - Phone:623-582-2010
Mailing Address - Fax:
Practice Address - Street 1:19841 N 27TH AVE STE 300A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4012
Practice Address - Country:US
Practice Address - Phone:623-582-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29670207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ67800Medicare PIN
AZZ67801Medicare PIN