Provider Demographics
NPI:1720415508
Name:DEMIR MEDICAL GROUP SC
Entity Type:Organization
Organization Name:DEMIR MEDICAL GROUP SC
Other - Org Name:DESERT WOMENS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HAINES
Authorized Official - Last Name:DEMIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-559-4776
Mailing Address - Street 1:8711 E PINNACLE PEAK RD
Mailing Address - Street 2:218
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3517
Mailing Address - Country:US
Mailing Address - Phone:480-559-4776
Mailing Address - Fax:866-526-7086
Practice Address - Street 1:80 N MCCLINTOCK DR # 104
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3767
Practice Address - Country:US
Practice Address - Phone:480-559-4776
Practice Address - Fax:866-526-7086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEMIR MEDICAL GROUP SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-11
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36773207V00000X, 261QM1300X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ503386Medicaid
AZ36773OtherAZ LICENSE
AZ11737757OtherCAQH
AZ203537Medicaid