=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336383900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIABEVITA MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2009
-----------------------------------------------------
Last Update Date | 08/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 E MCDONALD DR SUITE 105
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85250-6099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-315-9757
-----------------------------------------------------
Fax | 480-315-9758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7400 E MCDONALD DRIVE SUITE 105
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-315-9757
-----------------------------------------------------
Fax | 480-315-9758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER
-----------------------------------------------------
Name | DR. HELEN E HILTS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 480-315-9757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 22708
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------