Provider Demographics
NPI:1386689461
Name:NORTH SCOTTSDALE FAMILY MEDICINE ASSOCIATES PLC
Entity Type:Organization
Organization Name:NORTH SCOTTSDALE FAMILY MEDICINE ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BURGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:480-948-9903
Mailing Address - Street 1:6501 E GREENWAY PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2069
Mailing Address - Country:US
Mailing Address - Phone:480-948-9903
Mailing Address - Fax:866-837-0556
Practice Address - Street 1:6501 E GREENWAY PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2069
Practice Address - Country:US
Practice Address - Phone:480-948-9903
Practice Address - Fax:866-837-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ64017Medicare ID - Type Unspecified