Provider Demographics
NPI:1912212986
Name:ARIZONA CENTER FOR ADVANCED MEDICINE
Entity Type:Organization
Organization Name:ARIZONA CENTER FOR ADVANCED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MD(H)
Authorized Official - Phone:480-240-2600
Mailing Address - Street 1:9328 E RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2098
Mailing Address - Country:US
Mailing Address - Phone:480-240-2600
Mailing Address - Fax:480-240-2601
Practice Address - Street 1:9328 E RAINTREE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2098
Practice Address - Country:US
Practice Address - Phone:480-240-2600
Practice Address - Fax:480-240-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24896261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center