Organization
ADVANCED SPINE AND PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARRETT MICHAEL LEATHEM (DO OWNER)
(860) 670-2412
Entity
Organization
Contact information
Practice address
2563 S VAL VISTA DR STE 101B, GILBERT, AZ 85295-6231
(480) 573-0130
(480) 573-0131
Mailing address
2525 W GREENWAY RD STE 125, PHOENIX, AZ 85023-4226
(937) 206-0377
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/01/2022
Last updated
04/01/2022
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