MEDICARE: ANDOLORIS MEDICAL, PLLC

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	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1376020685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDOLORIS MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	3417 N 32ND ST STE B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5606
Country	:	US
Telephone Number	:	800-722-4446
Fax Number	:

Provider Business Practice Location Address
First Line	:	3417 N 32ND ST STE B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5606
Country	:	US
Telephone Number	:	800-722-4446
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JEFFREY DOUGLAS SCOTT
Credential	:
Telephone Number	:	602-368-3600

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	01/25/2019

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Directions to “ANDOLORIS MEDICAL, PLLC ” Practice Location

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