MEDICARE: VALLEY COLON AND RECTAL SURGICAL SPECIALISTS, 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	208C00000X	Colon & Rectal Surgery Physician	P-1760941-5	AZ

General Provider Information

NPI Number	:	1588924948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY COLON AND RECTAL SURGICAL SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3125
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85280-3125
Country	:	US
Telephone Number	:	314-432-2580
Fax Number	:	314-432-0223

Provider Business Practice Location Address
First Line	:	4153 SOUTH POWER RD
Second Line	:	SUITE 120
City	:	MESA
State	:	AZ
Zip	:	85212-3626
Country	:	US
Telephone Number	:	480-256-8128
Fax Number	:	888-430-0365

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARY ELIZABETH SCHULTHEIS
Credential	:	M.D.
Telephone Number	:	480-257-2736

Provider Enumeration Date	:	05/20/2012
Last Update Date	:	03/07/2013

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