Healthcare Provider Details

I. General information

NPI: 1134938376
Provider Name (Legal Business Name): BRIAN S PAGE DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 N 108TH AVE STE 134
PHOENIX AZ
85037-5466
US

IV. Provider business mailing address

20325 N 51ST AVE STE 160
GLENDALE AZ
85308-4622
US

V. Phone/Fax

Practice location:
  • Phone: 623-446-6350
  • Fax:
Mailing address:
  • Phone: 623-466-6350
  • Fax: 602-358-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL VON KOLEN
Title or Position: CFO
Credential:
Phone: 800-285-3755