Provider Demographics
NPI:1972929248
Name:HS CLINICAL SERVICES PC
Entity type:Organization
Organization Name:HS CLINICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:WALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-277-1170
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:623-277-1170
Mailing Address - Fax:623-277-1091
Practice Address - Street 1:25500 N NORTERRA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8200
Practice Address - Country:US
Practice Address - Phone:623-277-1170
Practice Address - Fax:623-277-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center