Healthcare Provider Details

I. General information

NPI: 1023574324
Provider Name (Legal Business Name): IMPULSE HEALTHCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE STE C500
PHOENIX AZ
85029-4600
US

IV. Provider business mailing address

1204 E BASELINE RD STE 106
TEMPE AZ
85283-1447
US

V. Phone/Fax

Practice location:
  • Phone: 602-699-6353
  • Fax: 602-699-6354
Mailing address:
  • Phone: 602-560-1204
  • Fax: 602-560-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW RHODES
Title or Position: ADMINISTRATOR
Credential: NP
Phone: 602-560-1204