1750674974 NPI number — SCOTTSDALE GENERAL MEDICAL CENTER

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 1750674974 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:
ESPERANZA CLINIC
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:
1750674974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2011
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:
TX - TEXAS
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:

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:
05/20/2011

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 "ARIZONA MEDICAL BOARD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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