Organization
ADVANCED SPINE AND PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARRETT MICHAEL LEATHEM (OWNER)
(480) 573-0130
Entity
Organization
Contact information
Practice address
13555 W MCDOWELL RD STE 207, GOODYEAR, AZ 85395-2628
(480) 573-0130
Mailing address
13555 W MCDOWELL RD STE 207, GOODYEAR, AZ 85395-2628
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/09/2020
Last updated
01/20/2021
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