Provider Demographics
NPI:1730112830
Name:EMPOWER EMERGENCY PHYSICIANS, PC
Entity Type:Organization
Organization Name:EMPOWER EMERGENCY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SHUFELDT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:480-221-8059
Mailing Address - Street 1:14818 N 74TH STREET
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-339-5088
Mailing Address - Fax:480-452-0823
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:ST. JOSEPH'S HOSPITAL & MEDICAL CENTER, EMERGENCY DEPT.
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-3361
Practice Address - Fax:602-406-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ784323Medicaid
AZ784323Medicaid