Provider Demographics
NPI:1447389747
Name:ARIZONA MEDICAL PSYCHOLOGY, PLC
Entity Type:Organization
Organization Name:ARIZONA MEDICAL PSYCHOLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH ROEMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-551-5469
Mailing Address - Street 1:PO BOX 18045
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85269-8045
Mailing Address - Country:US
Mailing Address - Phone:480-551-5469
Mailing Address - Fax:
Practice Address - Street 1:9630 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6267
Practice Address - Country:US
Practice Address - Phone:480-551-5469
Practice Address - Fax:480-551-5378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS19736Medicare UPIN
AZZ107440Medicare PIN