Provider Demographics
NPI:1851437412
Name:SCOTT M. JENSEN M.D. INC.
Entity Type:Organization
Organization Name:SCOTT M. JENSEN M.D. INC.
Other - Org Name:JENSEN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-381-2660
Mailing Address - Street 1:6682 LOWER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5064
Mailing Address - Country:US
Mailing Address - Phone:928-224-4270
Mailing Address - Fax:928-212-9017
Practice Address - Street 1:6682 LOWER RIDGE DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5064
Practice Address - Country:US
Practice Address - Phone:928-224-4270
Practice Address - Fax:928-212-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28925261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH52892Medicare UPIN