Provider Demographics
NPI:1093081879
Name:ASSOCIATES IN DERMATOLOGY CARE, PLLC
Entity Type:Organization
Organization Name:ASSOCIATES IN DERMATOLOGY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLUMETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-596-1110
Mailing Address - Street 1:11000 N SCOTTSDALE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6169
Mailing Address - Country:US
Mailing Address - Phone:480-596-1110
Mailing Address - Fax:480-596-9969
Practice Address - Street 1:11000 N SCOTTSDALE RD STE 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6169
Practice Address - Country:US
Practice Address - Phone:480-596-1110
Practice Address - Fax:480-596-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12450207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ281484002Medicaid
AZZ153606Medicare Oscar/Certification
AZZ154071Medicare Oscar/Certification
AZ281484002Medicaid