Provider Demographics
NPI:1447402870
Name:SCOTTSDALE HEALTHCARE
Entity Type:Organization
Organization Name:SCOTTSDALE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-882-4327
Mailing Address - Street 1:9201 E MOUNTAIN VIEW RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5140
Mailing Address - Country:US
Mailing Address - Phone:480-323-4682
Mailing Address - Fax:480-323-4688
Practice Address - Street 1:16101 N 82ND ST STE A-8
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1864
Practice Address - Country:US
Practice Address - Phone:480-323-1880
Practice Address - Fax:480-905-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 4315261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72092Medicare PIN