=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629208004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENCO MEDICAL, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2009
-----------------------------------------------------
Last Update Date | 05/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3993 E ROBIN LN
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-5416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-321-4077
-----------------------------------------------------
Fax | 480-515-1571
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3993 E ROBIN LN
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-5416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-321-4077
-----------------------------------------------------
Fax | 480-515-1571
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANNE TENDLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 602-321-4077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 37465
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------