1750672325 NPI number — SCOTTSDALE GENERAL MEDICAL CENTER

Table of content: (NPI 1750672325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750672325 NPI number — SCOTTSDALE GENERAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTTSDALE GENERAL MEDICAL CENTER
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:
SOUTHWESTERN MEDICAL CENTER
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:
1750672325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2065
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77252-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-820-1900
Provider Business Mailing Address Fax Number:
281-820-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 N MILLER RD
Provider Second Line Business Practice Location Address:
A-1
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85257-3658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-943-4673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER MANAGER
Authorized Official Telephone Number:
877-943-4673

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  32668 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 32668 . This is a "STATE OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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