Provider Demographics
NPI:1043821051
Name:SPECTACULAR MED LLC
Entity Type:Organization
Organization Name:SPECTACULAR MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRIMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-586-3220
Mailing Address - Street 1:9989 N 95TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4596
Mailing Address - Country:US
Mailing Address - Phone:480-586-3220
Mailing Address - Fax:480-586-3220
Practice Address - Street 1:9989 N 95TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4596
Practice Address - Country:US
Practice Address - Phone:480-586-3220
Practice Address - Fax:480-586-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory