1073784914 NPI number — INTERCARE MEDICAL ASSOCIATES LTD

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 1073784914 NPI number — INTERCARE MEDICAL ASSOCIATES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERCARE MEDICAL ASSOCIATES LTD
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:
1073784914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2303 N. 44TH STREET
Provider Second Line Business Mailing Address:
#14-1481
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-507-7444
Provider Business Mailing Address Fax Number:
480-507-1927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5011 N GRANITE REEF RD
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:
85250-7449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-941-2141
Provider Business Practice Location Address Fax Number:
480-941-4114
Provider Enumeration Date:
03/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AMBER
Authorized Official First Name:
SAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
480-941-2141

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  10916 , 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)





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