Healthcare Provider Details

I. General information

NPI: 1336881648
Provider Name (Legal Business Name): ALPHAMED NORTH VALLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9219 E HIDDEN SPUR TRL STE 200
SCOTTSDALE AZ
85255-6709
US

IV. Provider business mailing address

9219 E HIDDEN SPUR TRL STE 200
SCOTTSDALE AZ
85255-6709
US

V. Phone/Fax

Practice location:
  • Phone: 480-660-6052
  • Fax:
Mailing address:
  • Phone: 480-660-6052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CANTWELL
Title or Position: OWNER/PROVIDER
Credential: PA-C
Phone: 602-908-2025