Provider Demographics
NPI:1770798852
Name:OSTEOPATHIC MEDICAL CENTER OF SCOTTSDALE PC
Entity type:Organization
Organization Name:OSTEOPATHIC MEDICAL CENTER OF SCOTTSDALE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRONCOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-391-7631
Mailing Address - Street 1:9755 N 90TH ST
Mailing Address - Street 2:C-121
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5046
Mailing Address - Country:US
Mailing Address - Phone:480-391-7631
Mailing Address - Fax:480-314-5493
Practice Address - Street 1:9755 N 90TH ST
Practice Address - Street 2:C-121
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5046
Practice Address - Country:US
Practice Address - Phone:480-391-7631
Practice Address - Fax:480-314-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDO2849204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ76287Medicare ID - Type UnspecifiedGROUP PROVIDER ID