Healthcare Provider Details

I. General information

NPI: 1144785197
Provider Name (Legal Business Name): SCOTTSDALE MEDICAL PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 N MILLER RD STE 102
SCOTTSDALE AZ
85251-3697
US

IV. Provider business mailing address

4432 N MILLER RD STE 102
SCOTTSDALE AZ
85251-3697
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-7227
  • Fax:
Mailing address:
  • Phone: 480-306-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: CASSIDY GADDIS
Title or Position: CREDENTIALING OFFICER
Credential:
Phone: 480-306-7227