| Arizona State University | |
|
2150 E Orange St Tempe AZ 85281-4814 | |
| (480) 350-5878 | |
| Not Available |
| Full Name | Arizona State University |
|---|---|
| Speciality | Clinic/center |
| Location | 2150 E Orange St, Tempe, Arizona |
| Authorized Official Name and Position | Denise Link (ASSOCIATE DEAN FOR CLINICAL PRACTIC) |
| Authorized Official Contact | 6024960893 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Arizona State University 500 N 3rd St Room 482a Phoenix AZ 85004-2135 Ph: (602) 496-0893 | Arizona State University 2150 E Orange St Tempe AZ 85281-4814 Ph: (480) 350-5878 |
| NPI Number | 1194058917 |
|---|---|
| Provider Enumeration Date | 09/11/2009 |
| Last Update Date | 10/26/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194058917 | NPI | - | NPPES |
| Z21383 | Other | AZ | MEDICARE ID NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | OTC3716 (Arizona) | Primary |
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