1710757349 NPI number — HEALTH SCOTTSDALE

Table of content: (NPI 1710757349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710757349 NPI number — HEALTH SCOTTSDALE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH SCOTTSDALE
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:
Provider Other Organization Name Type Code:
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:
1710757349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9354 E THATCHER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85212-8539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-670-6397
Provider Business Mailing Address Fax Number:
480-914-3345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5111 N SCOTTSDALE RD STE 143
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85250-7076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-914-3320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
DERRICK
Authorized Official Title or Position:
CEO/NP
Authorized Official Telephone Number:
480-670-6397

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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