Healthcare Provider Details

I. General information

NPI: 1083680805
Provider Name (Legal Business Name): HOMER LEWIS SCHRECKENGOST D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23359 N PIMA RD # C-149
SCOTTSDALE AZ
85255-8380
US

IV. Provider business mailing address

23359 N PIMA RD # C-149
SCOTTSDALE AZ
85255-8380
US

V. Phone/Fax

Practice location:
  • Phone: 724-793-3557
  • Fax: 724-821-9698
Mailing address:
  • Phone: 724-793-3557
  • Fax: 724-821-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number006906
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: