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General NPI Number Information
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NPI Number | 1336322510
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE ADULT MEDICINE LLC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 10679 N. FRANK LLOYD WRIGHT BLVD. F101
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City | SCOTTSDALE
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State | AZ
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Zip | 85259
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Country | US
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Telephone | 480-229-8276
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Fax |
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Provider Business Mailing Address
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Address Line | 10679 N. FRANK LLOYD WRIGHT BLVD. F101
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City | SCOTTSDALE
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State | AZ
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Zip | 85259
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. GLENN HINCHMAN
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Credential | M.D.
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Telephone | 480-229-8276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25523
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License Number State | AZ
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