Organization
ADVANCED SPINE AND PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARRETT MICHAEL LEATHEM (MD, OWNER)
(860) 670-2412
Entity
Organization
Contact information
Practice address
4566 E INVERNESS AVE STE 205, MESA, AZ 85206-4634
(480) 640-0513
Mailing address
4566 E INVERNESS AVE STE 205, MESA, AZ 85206-4634
(480) 640-0513
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/03/2020
Last updated
01/20/2021
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