Provider Demographics
NPI:1558668715
Name:SHEA WOMENS CARE PC
Entity Type:Organization
Organization Name:SHEA WOMENS CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-767-0010
Mailing Address - Street 1:10105 E VIA LINDA
Mailing Address - Street 2:STE 103-282
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5311
Mailing Address - Country:US
Mailing Address - Phone:480-767-0010
Mailing Address - Fax:480-767-0030
Practice Address - Street 1:9522 E SAN SALVADOR DR
Practice Address - Street 2:#319
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5557
Practice Address - Country:US
Practice Address - Phone:480-767-0010
Practice Address - Fax:480-767-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ604367Medicaid