MEDICARE: SCOTTSDALE HEALTHCARE CORP

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1508122243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTTSDALE HEALTHCARE CORP

Provider Business Mailing Address
First Line	:	PO BOX 845635
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-5635
Country	:	US
Telephone Number	:	623-434-6200
Fax Number	:	623-434-6152

Provider Business Practice Location Address
First Line	:	3311 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-6477
Country	:	US
Telephone Number	:	480-882-7360
Fax Number	:	602-840-4250

Authorized Official
Title or Position	:	CEO
Name	:	MR. RICHARD SILVER
Credential	:
Telephone Number	:	623-434-6200

Provider Enumeration Date	:	04/06/2012
Last Update Date	:	02/02/2019

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Directions to “SCOTTSDALE HEALTHCARE CORP ” Practice Location

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