Provider Demographics
NPI:1639351547
Name:COLON & RECTAL CLINIC OF SCOTTSDALE
Entity Type:Organization
Organization Name:COLON & RECTAL CLINIC OF SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:LINETTE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-947-3533
Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:222
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5648
Mailing Address - Country:US
Mailing Address - Phone:480-947-3533
Mailing Address - Fax:480-947-3531
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:222
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-947-3533
Practice Address - Fax:480-947-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ83960Medicare PIN