Healthcare Provider Details

I. General information

NPI: 1174772487
Provider Name (Legal Business Name): SCOTTSDALE MEDICAL CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 N 92ND ST SUITE 101
SCOTTSDALE AZ
85258-4556
US

IV. Provider business mailing address

6501 E GREENWAY PKWY SUITE #103-492
SCOTTSDALE AZ
85254-2065
US

V. Phone/Fax

Practice location:
  • Phone: 480-614-5808
  • Fax: 480-614-5809
Mailing address:
  • Phone: 480-614-5808
  • Fax: 480-614-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number40913
License Number StateAZ

VIII. Authorized Official

Name: DR. JOSEPH A. ROTELLA
Title or Position: OWNER
Credential: MD
Phone: 480-614-5808