Provider Demographics
NPI:1952062127
Name:SCOTTSDALE MAT CLINIC
Entity Type:Organization
Organization Name:SCOTTSDALE MAT CLINIC
Other - Org Name:SMC - ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIWEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-414-2596
Mailing Address - Street 1:PO BOX 15124
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-5124
Mailing Address - Country:US
Mailing Address - Phone:480-998-4673
Mailing Address - Fax:
Practice Address - Street 1:10207 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-1424
Practice Address - Country:US
Practice Address - Phone:480-998-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility