Healthcare Provider Details

I. General information

NPI: 1750672325
Provider Name (Legal Business Name): SCOTTSDALE GENERAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 N MILLER RD A-1
SCOTTSDALE AZ
85257-3658
US

IV. Provider business mailing address

PO BOX 2065
HOUSTON TX
77252-2065
US

V. Phone/Fax

Practice location:
  • Phone: 877-943-4673
  • Fax:
Mailing address:
  • Phone: 281-820-1900
  • Fax: 281-820-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number32668
License Number StateAZ

VIII. Authorized Official

Name: CHARLES L ROGERS
Title or Position: OWNER MANAGER
Credential:
Phone: 877-943-4673