Provider Demographics
NPI:1144506064
Name:SCOTTSDALE HEALTHCARE CORP
Entity type:Organization
Organization Name:SCOTTSDALE HEALTHCARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAPORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-882-4904
Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 346
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5648
Mailing Address - Country:US
Mailing Address - Phone:480-882-6762
Mailing Address - Fax:480-882-6760
Practice Address - Street 1:13843 N TATUM BLVD
Practice Address - Street 2:UNIT 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5545
Practice Address - Country:US
Practice Address - Phone:480-882-6692
Practice Address - Fax:480-882-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ118562Medicare PIN