Provider Demographics
NPI:1750674974
Name:SCOTTSDALE GENERAL MEDICAL CENTER
Entity Type:Organization
Organization Name:SCOTTSDALE GENERAL MEDICAL CENTER
Other - Org Name:ESPERANZA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-943-4673
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:TX - TEXAS
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77252-2065
Mailing Address - Country:US
Mailing Address - Phone:281-820-1900
Mailing Address - Fax:
Practice Address - Street 1:1402 N MILLER RD
Practice Address - Street 2:A-1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3658
Practice Address - Country:US
Practice Address - Phone:877-943-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32668261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ32668OtherARIZONA MEDICAL BOARD