Provider Demographics
NPI:1376020685
Name:ANDOLORIS MEDICAL, PLLC
Entity Type:Organization
Organization Name:ANDOLORIS MEDICAL, PLLC
Other - Org Name:A-MED FACILITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-368-3600
Mailing Address - Street 1:3417 N 32ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5606
Mailing Address - Country:US
Mailing Address - Phone:800-722-4446
Mailing Address - Fax:
Practice Address - Street 1:3417 N 32ND ST STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5606
Practice Address - Country:US
Practice Address - Phone:800-722-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDOLORIS MEDICAL, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-19
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain