Provider Demographics
NPI:1912259862
Name:SCOTTSDALE HEALTHCARE CORP
Entity Type:Organization
Organization Name:SCOTTSDALE HEALTHCARE CORP
Other - Org Name:SCOTTSDALE HEALTHCARE PRIMARY CARE TEMPE
Other - Org Type:Doing Business As
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 1:1845 E BROADWAY RD
Practice Address - Street 2:STE 116
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1633
Practice Address - Country:US
Practice Address - Phone:480-882-7380
Practice Address - Fax:480-882-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ118562Medicare PIN