Healthcare Provider Details

I. General information

NPI: 1487793295
Provider Name (Legal Business Name): MARICOPA EAR NOSE & THROAT P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 W SOUTHERN AVE
TEMPE AZ
85282
US

IV. Provider business mailing address

2131 W SOUTHERN AVE
TEMPE AZ
85282
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-1200
  • Fax: 480-820-5743
Mailing address:
  • Phone: 480-820-1200
  • Fax: 480-820-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. THAD E BARTELL
Title or Position: PRESIDENT
Credential: MD
Phone: 480-820-1200