Provider Demographics
NPI:1366630592
Name:INTERWEST REHABILITATION - SCOTTSDALE, LLC
Entity Type:Organization
Organization Name:INTERWEST REHABILITATION - SCOTTSDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-634-7246
Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:STE. 120
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5648
Mailing Address - Country:US
Mailing Address - Phone:480-429-1771
Mailing Address - Fax:480-429-2498
Practice Address - Street 1:2960 N CIRCLE DR
Practice Address - Street 2:STE. 125
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1163
Practice Address - Country:US
Practice Address - Phone:719-634-7246
Practice Address - Fax:719-634-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I08597Medicare UPIN