Healthcare Provider Details

I. General information

NPI: 1396921367
Provider Name (Legal Business Name): FERTILITY TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 E CONFERENCE DR STE 115
TEMPE AZ
85284-2604
US

IV. Provider business mailing address

2155 E CONFERENCE DR SUITE 115
TEMPE AZ
85284-2604
US

V. Phone/Fax

Practice location:
  • Phone: 480-831-2445
  • Fax: 480-897-1283
Mailing address:
  • Phone: 480-831-2445
  • Fax: 480-897-1283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number98029
License Number StateAZ

VIII. Authorized Official

Name: JASON BRYANT BABCOCK
Title or Position: CEO
Credential:
Phone: 480-831-2445