Provider Demographics
NPI:1689831315
Name:FAMILY PRACTICE OF SCOTTSDALE
Entity Type:Organization
Organization Name:FAMILY PRACTICE OF SCOTTSDALE
Other - Org Name:FAMILY MEDICINE OF SCOTTSDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ELLSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-471-5702
Mailing Address - Street 1:9377 E BELL RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1502
Mailing Address - Country:US
Mailing Address - Phone:480-471-5702
Mailing Address - Fax:480-626-1916
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:SUITE 175
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-471-5702
Practice Address - Fax:480-626-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty