Provider Demographics
NPI:1770978041
Name:EMPOWER GREEN VALLEY PLLC
Entity type:Organization
Organization Name:EMPOWER GREEN VALLEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHUFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-339-5001
Mailing Address - Street 1:7332 E BUTHERUS DR HNGR 1
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-8005
Mailing Address - Country:US
Mailing Address - Phone:480-339-5001
Mailing Address - Fax:480-247-6482
Practice Address - Street 1:4455 S. I-19 FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:GREENVALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614
Practice Address - Country:US
Practice Address - Phone:520-808-2382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPOWER HOLDINGS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty