Provider Demographics
NPI:1619077435
Name:REGENT HEALTHCARE OF SCOTTSDALE
Entity Type:Organization
Organization Name:REGENT HEALTHCARE OF SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCN
Authorized Official - Phone:480-609-4244
Mailing Address - Street 1:4110 N SCOTTSDALE RD STE 315
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3999
Mailing Address - Country:US
Mailing Address - Phone:480-609-4244
Mailing Address - Fax:480-609-4382
Practice Address - Street 1:4110 N SCOTTSDALE RD STE 315
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3999
Practice Address - Country:US
Practice Address - Phone:480-609-4244
Practice Address - Fax:480-609-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7589111N00000X
AZ4276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105725Medicare ID - Type Unspecified
AZU80518Medicare UPIN