Provider Demographics
NPI:1033951843
Name:MOUNTAIN VIEW HEADACHE AND SPINE INSTITUTE PLLC
Entity type:Organization
Organization Name:MOUNTAIN VIEW HEADACHE AND SPINE INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUCHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-443-1263
Mailing Address - Street 1:2222 E HIGHLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4874
Mailing Address - Country:US
Mailing Address - Phone:602-767-0007
Mailing Address - Fax:602-767-0027
Practice Address - Street 1:9159 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4910
Practice Address - Country:US
Practice Address - Phone:602-767-0007
Practice Address - Fax:602-767-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty