=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396111936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDPOINT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2015
-----------------------------------------------------
Last Update Date | 09/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8300 E LONE MOUNTAIN RD
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85266-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-595-9527
-----------------------------------------------------
Fax | 480-452-1706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8300 E LONE MOUNTAIN RD
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85266-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-595-9527
-----------------------------------------------------
Fax | 480-452-1706
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | JUSTIN POSSNER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 480-595-9527
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 005348
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------