1730112830 NPI number — EMPOWER EMERGENCY PHYSICIANS, PC

Table of content: (NPI 1730112830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730112830 NPI number — EMPOWER EMERGENCY PHYSICIANS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPOWER EMERGENCY PHYSICIANS, PC
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:
1730112830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14818 N 74TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-339-5088
Provider Business Mailing Address Fax Number:
480-452-0823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 W THOMAS RD
Provider Second Line Business Practice Location Address:
ST. JOSEPH'S HOSPITAL & MEDICAL CENTER, EMERGENCY DEPT.
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85013-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-406-3361
Provider Business Practice Location Address Fax Number:
602-406-7165
Provider Enumeration Date:
07/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHUFELDT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
480-221-8059

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 784323 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017947700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".