Medspa by Soul Surgery, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

MEDSPA BY SOUL SURGERY, LLC

Practice address

14362 N Frank Lloyd Wright Blvd Ste B109
Scottsdale, AZ 85260-8881

Phone

(480) 912-3105

Fax

(480) 912-3106

NPI assigned

Aug 21, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Regina Shakespeare

Title

Billing Compliance Officer

Phone

(928) 554-5633

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1184104812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14362 N FRANK LLOYD WRIGHT BLVD STE B109",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852608881",
            "telephone_number": "480-912-3105",
            "fax_number": "480-912-3106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14362 N FRANK LLOYD WRIGHT BLVD STE B109",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852608881",
            "telephone_number": "480-912-3105",
            "fax_number": "480-912-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSPA BY SOUL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-21",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "SHAKESPEARE",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "BILLING COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "928-554-5633"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "XT4080190",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.