Healthcare Provider Details

I. General information

NPI: 1184103350
Provider Name (Legal Business Name): EVEREST MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 E BASELINE RD STE 105
MESA AZ
85206-4629
US

IV. Provider business mailing address

4864 E BASELINE RD STE 105
MESA AZ
85206-4629
US

V. Phone/Fax

Practice location:
  • Phone: 480-558-1900
  • Fax: 480-633-6086
Mailing address:
  • Phone: 480-558-1900
  • Fax: 480-633-6086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TY RUDDELL
Title or Position: CEO
Credential: DC
Phone: 480-510-9475