| Medspa By Soul Surgery, Llc | |
|
14362 N Frank Lloyd Wright Blvd Ste B109 Scottsdale AZ 85260-8881 | |
| (480) 912-3105 | |
| (480) 912-3106 |
| Full Name | Medspa By Soul Surgery, Llc |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 14362 N Frank Lloyd Wright Blvd Ste B109, Scottsdale, Arizona |
| Authorized Official Name and Position | Regina Shakespeare (BILLING COMPLIANCE OFFICER) |
| Authorized Official Contact | 9285545633 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medspa By Soul Surgery, Llc 14362 N Frank Lloyd Wright Blvd Ste B109 Scottsdale AZ 85260-8881 Ph: (480) 912-3105 | Medspa By Soul Surgery, Llc 14362 N Frank Lloyd Wright Blvd Ste B109 Scottsdale AZ 85260-8881 Ph: (480) 912-3105 |
| NPI Number | 1184104812 |
|---|---|
| Provider Enumeration Date | 08/21/2018 |
| Last Update Date | 01/31/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184104812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | XT4080190 (Arizona) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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