Provider Demographics
NPI:1144729351
Name:SCOTTSDALE CENTER OF REGENERATIVE MEDICINE
Entity type:Organization
Organization Name:SCOTTSDALE CENTER OF REGENERATIVE MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIGIEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-485-9390
Mailing Address - Street 1:13610 N SCOTTSDALE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4087
Mailing Address - Country:US
Mailing Address - Phone:602-485-9390
Mailing Address - Fax:
Practice Address - Street 1:13610 N SCOTTSDALE RD STE 10
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4087
Practice Address - Country:US
Practice Address - Phone:602-485-9390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10952261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center