Provider Demographics
NPI:1336881648
Name:ALPHAMED NORTH VALLEY LLC
Entity type:Organization
Organization Name:ALPHAMED NORTH VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:602-908-2025
Mailing Address - Street 1:9219 E HIDDEN SPUR TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6709
Mailing Address - Country:US
Mailing Address - Phone:480-660-6052
Mailing Address - Fax:
Practice Address - Street 1:9219 E HIDDEN SPUR TRL STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6709
Practice Address - Country:US
Practice Address - Phone:480-660-6052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON MEDICAL PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty