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NPI Code Detail

MEDICARE: ARIZONA STATE UNIVERSITY

MEDICARE: ARIZONA STATE UNIVERSITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/CenterOTC 4747AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3Z21383OTHERAZMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
203D0696288OTHERAZCLIA ID NUMBER

General Provider Information

NPI Number : 1447439195
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARIZONA STATE UNIVERSITY
Provider Business Mailing Address
First Line : 500 N 3RD ST
Second Line : SUITE 155
City : PHOENIX
State : AZ
Zip : 85004-2135
Country : US
Telephone Number : 602-496-0893
Fax Number :
Provider Business Practice Location Address
First Line : 3225 N CIVIC CENTER PLZ
Second Line : SUITE 10
City : SCOTTSDALE
State : AZ
Zip : 85251-6919
Country : US
Telephone Number : 480-884-1717
Fax Number : 480-884-1711
Authorized Official
Title or Position : ASSOCIATE DEAN
Name : DR. DENISE GIANNASCOLI LINK
Credential : DNSC
Telephone Number : 602-496-0893
Provider Enumeration Date : 10/30/2007
Last Update Date : 08/05/2010

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Directions to “ARIZONA STATE UNIVERSITY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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