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General NPI Number Information
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NPI Number | 1619568466
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Entity Type | Organization
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Legal Business Name | R&E ASSISTS LLC
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 17623 N 58TH PL
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5929
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Country | US
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Telephone | 602-525-2616
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Fax |
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Provider Business Mailing Address
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Address Line | 7878 N 16TH ST STE 250
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City | PHOENIX
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State | AZ
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Zip | 85020-4478
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Country | US
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Telephone | 602-395-0718
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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. SHANE LAMAR MARTIN
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Credential | MD
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Telephone | 602-328-0382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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