1548701618 NPI number — SCOTTSDALE HEART HEALTH & WELLNESS PLLC

Table of content: (NPI 1548701618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548701618 NPI number — SCOTTSDALE HEART HEALTH & WELLNESS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTTSDALE HEART HEALTH & WELLNESS PLLC
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:
HEALTHFINITY OF NORTHERN ARIZONA
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:
1548701618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11333 N SCOTTSDALE RD STE 115
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:
85254-5186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-765-2800
Provider Business Mailing Address Fax Number:
480-765-2799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 12TH PL
Provider Second Line Business Practice Location Address:
10
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86305-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-765-2800
Provider Business Practice Location Address Fax Number:
480-765-2799
Provider Enumeration Date:
03/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MALHOTRA
Authorized Official First Name:
RAHUL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-765-2800

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  32305 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 32305 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0902X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , with the licence number: 32305 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 32305 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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