Provider Demographics
NPI:1386033199
Name:GRETA M. IVERS, MD, PLLC
Entity Type:Organization
Organization Name:GRETA M. IVERS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-620-5336
Mailing Address - Street 1:9550 EAST THUNDERBIRD ROAD
Mailing Address - Street 2:UNIT 247
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:602-620-5336
Mailing Address - Fax:
Practice Address - Street 1:1825 EAST NORTHERN AVENUE
Practice Address - Street 2:SUITE 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-859-4584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47170261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service