Provider Demographics
NPI:1770914228
Name:MINIMALLY INVASIVE SPINE LLC
Entity type:Organization
Organization Name:MINIMALLY INVASIVE SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-265-8800
Mailing Address - Street 1:1301 E MCDOWELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2621
Mailing Address - Country:US
Mailing Address - Phone:602-265-8800
Mailing Address - Fax:602-265-8151
Practice Address - Street 1:4860 E BASELINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4669
Practice Address - Country:US
Practice Address - Phone:602-265-8800
Practice Address - Fax:602-265-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42500208600000X
AZ05299208VP0014X
AZ48105208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty