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Organization
ADVANCED SPINE AND PAIN LLC
Active
Organization
ADVANCED SPINE AND PAIN LLC
Active
Parent organization
ADVANCED SPINE AND PAIN LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVANCED SPINE AND PAIN LLC
Authorized official
JARRETT MICHAEL LEATHEM (OWNER)
(860) 670-2412
Entity
Organization
Contact information
Practice address
333 W THOMAS RD STE 204, PHOENIX, AZ 85013-4425
(480) 573-0130
(480) 573-0131
Mailing address
2525 W GREENWAY RD STE 125, PHOENIX, AZ 85023-4226
(480) 573-0130
(480) 573-0131
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
NULL
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
NULL
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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