Healthcare Provider Details

I. General information

NPI: 1730177288
Provider Name (Legal Business Name): REGENT MEDICAL CAVE CREEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16872 N CAVE CREEK RD
PHOENIX AZ
85032-2506
US

IV. Provider business mailing address

16872 N CAVE CREEK RD
PHOENIX AZ
85032-2506
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-7700
  • Fax: 602-494-3377
Mailing address:
  • Phone: 602-494-7700
  • Fax: 602-494-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: JEFF N FLOYD
Title or Position: OWNER
Credential: DC
Phone: 602-494-7700