Provider Demographics
NPI:1477222966
Name:RED MOUNTAIN WEIGHT LOSS SCOTTSDALE, LLC
Entity Type:Organization
Organization Name:RED MOUNTAIN WEIGHT LOSS SCOTTSDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-347-3413
Mailing Address - Street 1:14000 N HAYDEN RD STE 180
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5561
Mailing Address - Country:US
Mailing Address - Phone:480-347-3413
Mailing Address - Fax:
Practice Address - Street 1:8600 E SHEA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6683
Practice Address - Country:US
Practice Address - Phone:480-347-3413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0OtherNA