Provider Demographics
NPI:1124188578
Name:RICHARD J SETTLES
Entity Type:Organization
Organization Name:RICHARD J SETTLES
Other - Org Name:MEDICAL SUPERCENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-924-5914
Mailing Address - Street 1:6704 E BROADWAY RD
Mailing Address - Street 2:D-4
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1724
Mailing Address - Country:US
Mailing Address - Phone:480-924-5914
Mailing Address - Fax:
Practice Address - Street 1:6704 E BROADWAY RD
Practice Address - Street 2:D-4
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1724
Practice Address - Country:US
Practice Address - Phone:480-924-5914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2686332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5611640001OtherSUPPLIER NUMBER