Provider Demographics
NPI:1710942370
Name:SCOTTSDALE ENDOSCOPY CENTER PLC
Entity Type:Organization
Organization Name:SCOTTSDALE ENDOSCOPY CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-657-0889
Mailing Address - Street 1:9787 N 91ST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5088
Mailing Address - Country:US
Mailing Address - Phone:480-657-0889
Mailing Address - Fax:480-657-9277
Practice Address - Street 1:9787 N 91ST ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5088
Practice Address - Country:US
Practice Address - Phone:480-657-0889
Practice Address - Fax:480-657-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC3051261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ686826Medicaid
AZZ69160Medicare PIN