Provider Demographics
NPI:1669483996
Name:SCOTTSDALE BARIATRIC CENTER
Entity Type:Organization
Organization Name:SCOTTSDALE BARIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-391-3885
Mailing Address - Street 1:10200 N 92ND ST
Mailing Address - Street 2:STE 225
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4534
Mailing Address - Country:US
Mailing Address - Phone:480-391-3885
Mailing Address - Fax:480-355-6860
Practice Address - Street 1:10200 N 92ND ST
Practice Address - Street 2:STE 225
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4534
Practice Address - Country:US
Practice Address - Phone:480-391-3885
Practice Address - Fax:480-355-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76445Medicare ID - Type Unspecified