Healthcare Provider Details

I. General information

NPI: 1609201078
Provider Name (Legal Business Name): RISE WELLNESS CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 N 90TH ST STE 950
SCOTTSDALE AZ
85260-2774
US

IV. Provider business mailing address

15300 N 90TH ST STE 950
SCOTTSDALE AZ
85260-2774
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-2147
  • Fax: 480-941-2157
Mailing address:
  • Phone: 480-941-2147
  • Fax: 480-941-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2830
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2830
License Number StateAZ

VIII. Authorized Official

Name: ADAM WINTER
Title or Position: BILLING MANAGER
Credential:
Phone: 602-577-8836