Provider Demographics
NPI:1548599541
Name:SCOTTSDALE SEDATION MANAGEMENT, CO. LLC
Entity type:Organization
Organization Name:SCOTTSDALE SEDATION MANAGEMENT, CO. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SLEPAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-327-3557
Mailing Address - Street 1:8600 E VIA DE VENTURA
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3323
Mailing Address - Country:US
Mailing Address - Phone:480-948-4455
Mailing Address - Fax:
Practice Address - Street 1:8600 E VIA DE VENTURA
Practice Address - Street 2:SUITE 202
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3323
Practice Address - Country:US
Practice Address - Phone:480-948-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7043261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental