MEDICARE: FERTILITY TREATMENT CENTER, LLC

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	207VE0102X	Reproductive Endocrinology Physician	98029	AZ

General Provider Information

NPI Number	:	1396921367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERTILITY TREATMENT CENTER, LLC

Provider Business Mailing Address
First Line	:	2155 E CONFERENCE DR
Second Line	:	SUITE 115
City	:	TEMPE
State	:	AZ
Zip	:	85284-2604
Country	:	US
Telephone Number	:	480-831-2445
Fax Number	:	480-897-1283

Provider Business Practice Location Address
First Line	:	2155 E CONFERENCE DR STE 115
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-2604
Country	:	US
Telephone Number	:	480-831-2445
Fax Number	:	480-897-1283

Authorized Official
Title or Position	:	CEO
Name	:	JASON BRYANT BABCOCK
Credential	:
Telephone Number	:	480-831-2445

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	02/07/2024

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