Provider Demographics
NPI:1801266333
Name:MDAS LLC
Entity type:Organization
Organization Name:MDAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-349-2886
Mailing Address - Street 1:10769 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:A 120
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2682
Mailing Address - Country:US
Mailing Address - Phone:480-848-0991
Mailing Address - Fax:480-452-0929
Practice Address - Street 1:10769 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:A 120
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2682
Practice Address - Country:US
Practice Address - Phone:480-848-0991
Practice Address - Fax:480-452-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty