Provider Demographics
NPI:1225235922
Name:SCOTTSDALE PERINATAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:SCOTTSDALE PERINATAL ASSOCIATES LLC
Other - Org Name:AMOMI PREGNANCY WELLNESS - SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-967-7664
Mailing Address - Street 1:6950 E CHAUNCEY LANE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5180
Mailing Address - Country:US
Mailing Address - Phone:480-970-7664
Mailing Address - Fax:480-970-1907
Practice Address - Street 1:6950 E CHAUNCEY LANE
Practice Address - Street 2:SUITE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5180
Practice Address - Country:US
Practice Address - Phone:480-970-7664
Practice Address - Fax:480-970-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24440207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020531Medicaid