Healthcare Provider Details

I. General information

NPI: 1245779784
Provider Name (Legal Business Name): SCOTTSDALE HEALTHCARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E RIO SALADO PKWY BUILDING C, STE. 110-113
TEMPE AZ
85281-0803
US

IV. Provider business mailing address

PO BOX 845635
LOS ANGELES CA
90084-5635
US

V. Phone/Fax

Practice location:
  • Phone: 623-266-4699
  • Fax:
Mailing address:
  • Phone: 623-434-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD SILVER
Title or Position: CEO
Credential:
Phone: 623-434-6200