Glendale Interventional Treatment Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GLENDALE INTERVENTIONAL TREATMENT CENTER LLC

Practice address

6320 W Union Hills Dr Ste 1400B
Glendale, AZ 85308-1061

Phone

(623) 688-5400

NPI assigned

Feb 7, 2020

Last updated

Feb 7, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shawn Vigneau, DC

Title

Sole Member

Phone

(480) 930-4018

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1581033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581033600000",
    "number": "1245862275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6320 W UNION HILLS DR STE 1400B",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6320 W UNION HILLS DR STE 1400B",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081061",
            "telephone_number": "623-688-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE INTERVENTIONAL TREATMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-07",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A",
        "authorized_official_last_name": "VIGNEAU",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "480-930-4018",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Glendale Medical Clinic LLC
• Glendale Medical Investors Limited Partnership (Life Care Center of North Glendale)
• Glendale Medical Supply
• Glendale Modern Dentistry, LLP (Glendale Modern Dentistry)
• Glendale Obstetrics and Gynecology PC

• Ambulatory Surgical Clinic/Center in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 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.