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Organization
GLENDALE INTERVENTIONAL TREATMENT CENTER LLC
Active
Organization
GLENDALE INTERVENTIONAL TREATMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN VIGNEAU DC (SOLE MEMBER)
(480) 930-4018
Entity
Organization
Contact information
Practice address
6320 W UNION HILLS DR STE 1400B, GLENDALE, AZ 85308-1061
(623) 688-5400
Mailing address
6320 W UNION HILLS DR STE 1400B, GLENDALE, AZ 85308-1061
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
02/07/2020
Last updated
02/07/2020
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