Provider Demographics
NPI:1700060118
Name:NEUROCARE OF SCOTTSDALE, PLLC
Entity Type:Organization
Organization Name:NEUROCARE OF SCOTTSDALE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-451-7676
Mailing Address - Street 1:10250 N 92ND ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4510
Mailing Address - Country:US
Mailing Address - Phone:480-451-7676
Mailing Address - Fax:480-451-0971
Practice Address - Street 1:10250 N 92ND ST
Practice Address - Street 2:SUITE 304
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4510
Practice Address - Country:US
Practice Address - Phone:480-451-7676
Practice Address - Fax:480-451-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78531Medicare PIN