| Scottsdale Internal Medicine Pllc | |
|
4643 N 12th St Ste 101 Phoenix AZ 85014-4083 | |
| (602) 812-3789 | |
| Not Available |
| Full Name | Scottsdale Internal Medicine Pllc |
|---|---|
| Speciality | Clinical Nurse Specialist |
| Location | 4643 N 12th St Ste 101, Phoenix, Arizona |
| Authorized Official Name and Position | Charles Benjamin Evans (OWNER) |
| Authorized Official Contact | 6022920552 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scottsdale Internal Medicine Pllc 4643 N 12th St Ste 101 Phoenix AZ 85014-4083 Ph: (602) 812-3789 | Scottsdale Internal Medicine Pllc 4643 N 12th St Ste 101 Phoenix AZ 85014-4083 Ph: (602) 812-3789 |
| NPI Number | 1790050409 |
|---|---|
| Provider Enumeration Date | 03/13/2012 |
| Last Update Date | 02/29/2024 |
| Medicare PECOS PAC ID | 8325339468 |
|---|---|
| Medicare Enrollment ID | O20160621002453 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790050409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 364SA2200X | Clinical Nurse Specialist - Adult Health | (* (Not Available)) | Primary |
| Provider Name | Charles B Evans |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275754517 PECOS PAC ID: 5193811578 Enrollment ID: I20071016000336 |
| Provider Name | Charlene F Baldwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033546411 PECOS PAC ID: 2961628292 Enrollment ID: I20140730002884 |
| Provider Name | Christina Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043684012 PECOS PAC ID: 8224331525 Enrollment ID: I20160120001818 |
| Provider Name | Teresa Marie Gaither |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568835890 PECOS PAC ID: 9931480985 Enrollment ID: I20170105000804 |
| Provider Name | Nicholas Archer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053861583 PECOS PAC ID: 5597025510 Enrollment ID: I20180212001216 |
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