Provider Demographics
NPI:1902219256
Name:NEW DIRECTION FERTILITY CENTERS
Entity Type:Organization
Organization Name:NEW DIRECTION FERTILITY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:AMOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-351-8222
Mailing Address - Street 1:4824 E BASELINE RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4676
Mailing Address - Country:US
Mailing Address - Phone:480-351-8222
Mailing Address - Fax:480-351-8221
Practice Address - Street 1:4824 E BASELINE RD
Practice Address - Street 2:SUITE 132
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4676
Practice Address - Country:US
Practice Address - Phone:480-351-8222
Practice Address - Fax:480-351-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44728207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1528048006OtherINDIVIDUAL NPI