1639481138 NPI number — SCOTTSDALE HEALTHCARE CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639481138 NPI number — SCOTTSDALE HEALTHCARE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTTSDALE HEALTHCARE CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SCOTTSDALE HEALTHCARE NEUROSCIENCES CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639481138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POX 845635
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90084-5635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-434-6200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10250 N 92ND ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-451-7676
Provider Business Practice Location Address Fax Number:
480-451-0971
Provider Enumeration Date:
07/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SILVER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
623-434-6200

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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