Provider Demographics
NPI:1376952820
Name:SCOTTSDALE HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:SCOTTSDALE HEALTHCARE CORPORATION
Other - Org Name:SCOTTSDALE HEALTHCARE PRIMARY CARE MIDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-434-6200
Mailing Address - Street 1:PO BOX 845635
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5635
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:623-434-6164
Practice Address - Street 1:5111 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7075
Practice Address - Country:US
Practice Address - Phone:480-882-7410
Practice Address - Fax:480-451-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty