Healthcare Provider Details

I. General information

NPI: 1336322510
Provider Name (Legal Business Name): SCOTTSDALE ADULT MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10679 N. FRANK LLOYD WRIGHT BLVD. F101
SCOTTSDALE AZ
85259
US

IV. Provider business mailing address

10679 N. FRANK LLOYD WRIGHT BLVD. F101
SCOTTSDALE AZ
85259
US

V. Phone/Fax

Practice location:
  • Phone: 480-229-8276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number25523
License Number StateAZ

VIII. Authorized Official

Name: DR. GLENN HINCHMAN
Title or Position: OWNER/MANAGER
Credential: M.D.
Phone: 480-229-8276