NPIMap

Organization Active NPI

Cleanslate Medical Group of Arizona PLLC

  • Addiction Medicine (Internal Medicine) Physician
  • Phoenix, AZ
National Provider Identifier
1326585662
Registry record updated Jul 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
CLEANSLATE MEDICAL GROUP OF ARIZONA PLLC
Practice address
8410 W Thomas
Phoenix, AZ 85037
Phone
(413) 584-2173
NPI assigned
Jan 25, 2017
Last updated
Jul 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2019

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

Authorized official

Name
Robert Hutchison
Title
Cfo
Phone
(615) 425-0220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Internal Medicine) Physician 207RA0401X NU Primary

Addresses

Primary practice location

8410 W Thomas
Phoenix, AZ 85037

Mailing address

15 Century Blvd Ste 307
Nashville, TN 37214-3692
Phone (615) 425-0220

National Provider Directory

National Provider Directory
Tax ID family
Cleanslate Medical Group of Arizona PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15255 N 40th St
Ste 135
Phoenix, AZ 85032
Phone (480) 417-4215

8410 W Thomas Rd
Phoenix, AZ 85037
Phone (480) 417-5289

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1326585662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 CENTURY BLVD STE 307",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372143692",
            "telephone_number": "615-425-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8410 W THOMAS",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85037",
            "telephone_number": "413-584-2173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEANSLATE MEDICAL GROUP OF ARIZONA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-25",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "HUTCHISON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "615-425-0220"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; 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.