# ADVANCED SPINE AND PAIN LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ADVANCED SPINE AND PAIN LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639951577
- **Legal business name:** ADVANCED SPINE AND PAIN LLC
- **Authorized official:** JARRETT MICHAEL LEATHEM (OWNER)
- **Authorized official phone:** (860) 670-2412

## Contact information

- **Practice address:** 333 W THOMAS RD STE 204, PHOENIX, AZ 85013-4425
- **Practice address phone:** (480) 573-0130
- **Practice address fax:** (480) 573-0131
- **Mailing address:** 2525 W GREENWAY RD STE 125, PHOENIX, AZ 85023-4226
- **Mailing address phone:** (480) 573-0130
- **Mailing address fax:** (480) 573-0131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |
| 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