Provider Demographics
NPI:1801876941
Name:SKIN CANCER TREATMENT CENTER, P.C.
Entity type:Organization
Organization Name:SKIN CANCER TREATMENT CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARROLL-CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-875-2600
Mailing Address - Street 1:13128 N 94TH DR
Mailing Address - Street 2:SUITE #101A
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4254
Mailing Address - Country:US
Mailing Address - Phone:623-875-2600
Mailing Address - Fax:623-875-2621
Practice Address - Street 1:13128 N 94TH DR
Practice Address - Street 2:SUITE #101A
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4254
Practice Address - Country:US
Practice Address - Phone:623-875-2600
Practice Address - Fax:623-875-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC3048261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ69251Medicare PIN