Basic Information
| Provider Information | |||||||||
| NPI: | 1821494204 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTTSDALE HEALTHCARE CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 845635 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900845635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234346200 | ||||||||
| FaxNumber: | 6234346152 | ||||||||
| Practice Location | |||||||||
| Address1: | 1626 S PRIEST DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852816204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808827320 | ||||||||
| FaxNumber: | 4809677920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2014 | ||||||||
| LastUpdateDate: | 02/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | SILVER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6234346200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.