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General NPI Number Information
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NPI Number | 1457719569
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Entity Type | Organization
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Legal Business Name | PRIVATE CLIENT PHYSICIAN SERVICES, LLC
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 5851 E BLUE SKY DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85266-6712
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Country | US
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Telephone | 480-868-8984
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Fax |
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Provider Business Mailing Address
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Address Line | 5851 E BLUE SKY DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85266-6712
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Country | US
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Telephone | 480-868-8984
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEVIN R BOOTHE
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Credential | M.D.
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Telephone | 480-639-7886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 41445
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License Number State | AZ
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