Healthcare Provider Details

I. General information

NPI: 1194451989
Provider Name (Legal Business Name): ARTEMIS OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 W NORTHERN AVE STE 108
PHOENIX AZ
85051-6641
US

IV. Provider business mailing address

7101 E OAKMONT DR
PARADISE VALLEY AZ
85253-2728
US

V. Phone/Fax

Practice location:
  • Phone: 602-469-9466
  • Fax:
Mailing address:
  • Phone: 601-469-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. NILESH PATEL
Title or Position: DR
Credential: MD
Phone: 602-469-9466