Provider Demographics
NPI:1689427239
Name:SAGUARO BLOOM MED SPA LLC
Entity Type:Organization
Organization Name:SAGUARO BLOOM MED SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:AGACNP-BC
Authorized Official - Phone:314-707-5676
Mailing Address - Street 1:5243 E THUNDER HAWK RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5593
Mailing Address - Country:US
Mailing Address - Phone:314-707-5676
Mailing Address - Fax:
Practice Address - Street 1:15323 N SCOTTSDALE ROAD
Practice Address - Street 2:SUITE 180, ROOM 12
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:315-707-5676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service