MEDICARE: FIRST NATIONS LIMB PRESERVATION FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician	45866	AZ

General Provider Information

NPI Number	:	1013439520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST NATIONS LIMB PRESERVATION FOUNDATION

Provider Business Mailing Address
First Line	:	4904 S POWER RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-3609
Country	:	US
Telephone Number	:	480-840-4230
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 E MCKELLIPS RD STE 111
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-2525
Country	:	US
Telephone Number	:	480-840-4230
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT BRANNAN
Credential	:	MD
Telephone Number	:	480-840-4230

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	03/17/2018

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