Organization
ADVANCED SPINE AND PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARRETT MICHAEL LEATHEM (DO, OWNER)
(480) 573-0130
Entity
Organization
Contact information
Practice address
15571 N REEMS RD BLDG D, SURPRISE, AZ 85374-9584
(480) 573-0130
Mailing address
PO BOX 29901, DEPARTMENT ID 975, PHOENIX, AZ 85038-0901
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207X00000X
Orthopaedic Surgery 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
12/14/2021
Last updated
12/14/2021
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