Provider Demographics
NPI:1710168083
Name:SCOTTSDALE SURGICAL CONSULTANTS PC
Entity Type:Organization
Organization Name:SCOTTSDALE SURGICAL CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WOLVOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-421-1991
Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 234
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5648
Mailing Address - Country:US
Mailing Address - Phone:480-421-1991
Mailing Address - Fax:480-421-1996
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 234
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-421-1991
Practice Address - Fax:480-421-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27673208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA38485Medicare UPIN
AZZ65367Medicare PIN