MEDICARE: STEVE MENDENHALL REPT

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	1104	AZ

General Provider Information

NPI Number	:	1548989635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVE MENDENHALL REPT

Provider Business Mailing Address
First Line	:	8655 E VIA DE VENTURA STE E155
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3354
Country	:	US
Telephone Number	:	480-596-1686
Fax Number	:	480-483-8455

Provider Business Practice Location Address
First Line	:	8655 E VIA DE VENTURA STE E155
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3354
Country	:	US
Telephone Number	:	480-596-1686
Fax Number	:	480-483-8455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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