Provider Demographics
NPI:1790217792
Name:SCOTTSDALE PROFESSIONAL LLC
Entity Type:Organization
Organization Name:SCOTTSDALE PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-503-5711
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:MILAM
Mailing Address - State:TX
Mailing Address - Zip Code:75959-0096
Mailing Address - Country:US
Mailing Address - Phone:225-588-4845
Mailing Address - Fax:602-926-8841
Practice Address - Street 1:18521 E QUEEN CREEK RD
Practice Address - Street 2:STE 105-161
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5866
Practice Address - Country:US
Practice Address - Phone:720-503-5711
Practice Address - Fax:602-926-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty