Provider Demographics
NPI:1790041903
Name:SMAX LLC
Entity Type:Organization
Organization Name:SMAX LLC
Other - Org Name:ENVOQUE MD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-289-3690
Mailing Address - Street 1:4220 E MCDOWELL RD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-9743
Mailing Address - Country:US
Mailing Address - Phone:480-289-3690
Mailing Address - Fax:480-289-3694
Practice Address - Street 1:4220 E MCDOWELL RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-9743
Practice Address - Country:US
Practice Address - Phone:480-289-3690
Practice Address - Fax:480-289-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty