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General NPI Number Information
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NPI Number | 1184103350
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Entity Type | Organization
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Legal Business Name | EVEREST MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 4864 E BASELINE RD STE 105
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City | MESA
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State | AZ
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Zip | 85206-4629
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Country | US
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Telephone | 480-558-1900
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Fax | 480-633-6086
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Provider Business Mailing Address
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Address Line | 4864 E BASELINE RD STE 105
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City | MESA
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State | AZ
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Zip | 85206-4629
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Country | US
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Telephone | 480-558-1900
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Fax | 480-633-6086
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Authorized Official
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Title or Position | CEO
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Name | DR. TY RUDDELL
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Credential | DC
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Telephone | 480-510-9475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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