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General NPI Number Information
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NPI Number | 1144729351
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE CENTER OF REGENERATIVE MEDICINE
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Dates
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Enumeration Date | 02/03/2018
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Last Update Date | 02/03/2018
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Provider Practice Location Address
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Address Line | 13610 N SCOTTSDALE RD STE 10
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4087
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Country | US
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Telephone | 602-485-9390
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Fax |
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Provider Business Mailing Address
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Address Line | 13610 N SCOTTSDALE RD STE 10
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4087
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Country | US
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Telephone | 602-485-9390
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEITH SMIGIEL
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Credential | NP
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Telephone | 602-485-9390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AP10952
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License Number State | AZ
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