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General NPI Number Information
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NPI Number | 1740731918
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Entity Type | Organization
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Legal Business Name | IMED SURGICAL SOLUTIONS LLC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 8424 E SHEA BLVD STE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6662
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Country | US
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Telephone | 480-244-1257
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12752
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City | CHANDLER
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State | AZ
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Zip | 85248-0030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ESTHER FLETCHER
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Credential | PA-C
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Telephone | 480-244-1257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5067
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License Number State | AZ
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