Healthcare Provider Details

I. General information

NPI: 1265986467
Provider Name (Legal Business Name): COLUMBIA PALLIATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15849 N 71ST ST SUITE 100
SCOTTSDALE AZ
85254-2179
US

IV. Provider business mailing address

15849 N 71ST ST SUITE 100
SCOTTSDALE AZ
85254-2179
US

V. Phone/Fax

Practice location:
  • Phone: 877-811-3676
  • Fax:
Mailing address:
  • Phone: 877-811-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. J D BALL
Title or Position: PRESIDENT
Credential:
Phone: 480-384-0030