Healthcare Provider Details

I. General information

NPI: 1801842927
Provider Name (Legal Business Name): THUNDERBIRD ENDOSCOPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5823 W EUGIE AVE STE B
GLENDALE AZ
85304-1276
US

IV. Provider business mailing address

5823 W EUGIE AVE STE B
GLENDALE AZ
85304-1276
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-1717
  • Fax: 602-938-0292
Mailing address:
  • Phone: 602-439-1717
  • Fax: 602-938-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License NumberOSC 2750
License Number StateAZ

VIII. Authorized Official

Name: SHIRLEY SCHULLER
Title or Position: CLINICAL DIRECTOR
Credential: RN
Phone: 602-439-1717