# GLENDALE INTERVENTIONAL TREATMENT CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245862275
- **Authorized official:** SHAWN VIGNEAU DC (SOLE MEMBER)
- **Authorized official phone:** (480) 930-4018

## Contact information

- **Practice address:** 6320 W UNION HILLS DR STE 1400B, GLENDALE, AZ 85308-1061
- **Practice address phone:** (623) 688-5400
- **Mailing address:** 6320 W UNION HILLS DR STE 1400B, GLENDALE, AZ 85308-1061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/07/2020
- **Last updated:** 02/07/2020