Provider Demographics
NPI:1306243142
Name:KIERLAND MEDICAL, LLC
Entity type:Organization
Organization Name:KIERLAND MEDICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SMITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-998-1685
Mailing Address - Street 1:7047 E GREENWAY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-8107
Mailing Address - Country:US
Mailing Address - Phone:480-998-1685
Mailing Address - Fax:480-998-1754
Practice Address - Street 1:7047 E GREENWAY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-8107
Practice Address - Country:US
Practice Address - Phone:480-998-1685
Practice Address - Fax:480-998-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center