Provider Demographics
NPI:1255586483
Name:SCOTTSDALE HEALTHCARE CORP.
Entity type:Organization
Organization Name:SCOTTSDALE HEALTHCARE CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-434-6200
Mailing Address - Street 1:PO BOX 845635
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5635
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:
Practice Address - Street 1:10290 N 92ND ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4522
Practice Address - Country:US
Practice Address - Phone:480-323-1280
Practice Address - Fax:480-323-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ389661Medicaid
AZZ118562Medicare PIN