Provider Demographics
NPI:1861522419
Name:JOHN S BICKLE DO PLC
Entity type:Organization
Organization Name:JOHN S BICKLE DO PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-595-8900
Mailing Address - Street 1:33755 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1567
Mailing Address - Country:US
Mailing Address - Phone:480-595-8900
Mailing Address - Fax:480-595-8910
Practice Address - Street 1:33755 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1567
Practice Address - Country:US
Practice Address - Phone:480-595-8900
Practice Address - Fax:480-595-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0714850OtherBLUE CROSS
AZZ115231Medicare PIN
AZAZ0714850OtherBLUE CROSS