Provider Demographics
NPI:1689799579
Name:SCOTTSDALE PHYSICIANS GROUP PLC
Entity Type:Organization
Organization Name:SCOTTSDALE PHYSICIANS GROUP PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHADIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-353-5420
Mailing Address - Street 1:7975 N HAYDEN RD STE C380
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3265
Mailing Address - Country:US
Mailing Address - Phone:480-214-9720
Mailing Address - Fax:480-214-9722
Practice Address - Street 1:7975 N HAYDEN RD STE D354
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3243
Practice Address - Country:US
Practice Address - Phone:480-214-9720
Practice Address - Fax:480-214-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ909575Medicaid
AZZ101090Medicare PIN