Healthcare Provider Details

I. General information

NPI: 1144860800
Provider Name (Legal Business Name): FUSION MEDICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 N GRANITE REEF RD STE 102
SCOTTSDALE AZ
85250-6280
US

IV. Provider business mailing address

10078 E PERSHING AVE
SCOTTSDALE AZ
85260-7221
US

V. Phone/Fax

Practice location:
  • Phone: 602-703-7276
  • Fax:
Mailing address:
  • Phone: 602-703-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA GOLD
Title or Position: OWNER
Credential: RPH
Phone: 602-703-7275