MEDICARE: SCOTTSDALE BARIATRIC CENTER

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	174400000X	Specialist

General Provider Information

NPI Number	:	1669483996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTTSDALE BARIATRIC CENTER

Provider Business Mailing Address
First Line	:	10200 N 92ND ST
Second Line	:	STE 225
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4534
Country	:	US
Telephone Number	:	480-391-3885
Fax Number	:	480-355-6860

Provider Business Practice Location Address
First Line	:	10200 N 92ND ST
Second Line	:	STE 225
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4534
Country	:	US
Telephone Number	:	480-391-3885
Fax Number	:	480-355-6860

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ROBIN BLACKSTONE
Credential	:	MD
Telephone Number	:	480-391-3885

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	08/22/2020

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Directions to “SCOTTSDALE BARIATRIC CENTER ” Practice Location

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