Healthcare Provider Details

I. General information

NPI: 1104192715
Provider Name (Legal Business Name): SCOTTSDALE ACCIDENT AND INJURY MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9188 E SAN SALVADOR DR STE 201
SCOTTSDALE AZ
85258-5562
US

IV. Provider business mailing address

9188 E SAN SALVADOR DR STE 201
SCOTTSDALE AZ
85258-5562
US

V. Phone/Fax

Practice location:
  • Phone: 480-292-8877
  • Fax: 480-292-8868
Mailing address:
  • Phone: 480-292-8877
  • Fax: 480-292-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number03720
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2479
License Number StateAZ

VIII. Authorized Official

Name: MARK P SIEGEL
Title or Position: OWNER
Credential: D.O.
Phone: 480-292-8877