Active NPI
Panacea Brain and Spine, LLC
- Non-Pharmacy Dispensing Site
- Lake Havasu City, AZ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Non-Pharmacy Dispensing Site
- Legal business name
- PANACEA BRAIN AND SPINE, LLC
- Practice address
- 297 Lake Havasu Ave S
Suite 204
Lake Havasu City, AZ 86403-6526 - Phone
- (928) 453-2211
- NPI assigned
- Apr 22, 2013
- Organization subpart
- Yes
- Parent organization
- PANACEA BRAIN AND SPINE, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Chad E. Hartley, MD
- Title
- Owner
- Phone
- (928) 453-2211
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Non-Pharmacy Dispensing Site | 332900000X | Primary |
Addresses
Primary practice location
297 Lake Havasu Ave S
Suite 204
Lake Havasu City, AZ 86403-6526
Mailing address
2980 N Beverly Glen Cir
Suite 301
Los Angeles, CA 90077-1726
Phone (310) 474-9809
National Provider Directory
National Provider Directory- Part of
- Panacea Brain and Spine LLC
Interoperability endpoints
- https://api.platform.athenahealth.com/5773/brand/1/csg/1/fhir/r4
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Neurological Surgery Physician
- Lake Havasu City, AZ
- NPI 1457622763
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Neurological Surgery Physician
- Lake Havasu City, AZ
- NPI 1457513749
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366588800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1366588800000",
"number": "1154765121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2980 N BEVERLY GLEN CIR",
"address_2": "SUITE 301",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900771726",
"telephone_number": "310-474-9809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "297 LAKE HAVASU AVE S",
"address_2": "SUITE 204",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "864036526",
"telephone_number": "928-453-2211"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PANACEA BRAIN AND SPINE, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PANACEA BRAIN AND SPINE, LLC",
"enumeration_date": "2013-04-22",
"last_updated": "2013-04-22",
"status": "A",
"authorized_official_last_name": "HARTLEY",
"authorized_official_first_name": "CHAD",
"authorized_official_middle_name": "E.",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "928-453-2211",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "332900000X",
"taxonomy_group": "",
"desc": "Non-Pharmacy Dispensing Site",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Havasu City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.