Healthcare Provider Details

I. General information

NPI: 1851914634
Provider Name (Legal Business Name): BEITLER HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SOUTHERN AVE STE 2020
MESA AZ
85206-6213
US

IV. Provider business mailing address

PO BOX 1565
HIGLEY AZ
85236-1565
US

V. Phone/Fax

Practice location:
  • Phone: 480-582-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARY BEITLER
Title or Position: PHYSICIAN
Credential:
Phone: 480-582-5555