Healthcare Provider Details
I. General information
NPI: 1831501121
Provider Name (Legal Business Name): SAV HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/21/2014
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1000 E WARNER RD 107
TEMPE AZ
85284-3224
US
IV. Provider business mailing address
PO BOX 2954
PHOENIX AZ
85062-2954
US
V. Phone/Fax
- Phone: 480-897-3300
- Fax: 480-897-3312
- Phone: 602-889-5833
- Fax: 602-889-5834
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | |
| License Number State | AZ |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171M00000X |
| Taxonomy | Case Manager/Care Coordinator |
| License Number | |
| License Number State | AZ |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207ZP0102X |
| Taxonomy | Anatomic Pathology & Clinical Pathology Physician |
| License Number | |
| License Number State | AZ |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | |
| License Number State | AZ |
VIII. Authorized Official
Name: MR.
SHAWN
VIGNEAU
Title or Position: OWNER
Credential:
Phone: 602-889-5833