| NPI | 1366048860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARRETT MICHAEL LEATHEM Owner 480-573-0130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine | |
| 208VP0000X Pain Medicine Pain Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2021-01-20 |