Scott M Bolhack, MD
Individual provider Active NPI Geriatric Medicine (Internal Medicine) Physician · Tucson, AZ
NPI 1730160573 · NPPES record last updated Mar 22, 2019
Key facts
- NPI
- 1730160573
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician 207RG0300X
- License
- 20393 (AZ)
- Practice address
- 5130 North Circulo Sobrio
Tucson, AZ 85718-6036 - Phone
- (520) 670-0745
- Fax
- (520) 509-4496
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040902000924 | AZ | Practitioner - Internal Medicine |
8426962424 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TLC Healthcare Medical Group PC | Internal Medicine | Current |
Accepting new patients |
| Tucson Long Term Care Medical Group | Internal Medicine | Past |
Accepting new patients |
| Northwest Allied Physicians, LLC | Past | Accepting new patients | |
| Northwest Allied Physicians LLC | Internal Medicine | Past |
Accepting new patients |
| Archie Hendricks Sr Skilled Nursing Facility | Past | Accepting new patients |
Locations
1775 E Skyline Dr
Ste 101
Tucson, AZ 85718
Phone (520) 615-6200
13101 N Oracle Rd
Ste 169
Tucson, AZ 85739
Phone (520) 615-6200
2850 N Country Club Rd
Tucson, AZ 85716
Phone 52032262747104
Interoperability endpoints
- scott.bolhack.1@30710.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 20393 | AZ | Yes |
| Pediatrics Physician | 208000000X | 20393 | AZ |
Addresses
Primary practice location
5130 North Circulo Sobrio
Tucson, AZ 85718-6036
Mailing address
2850 North Country Club Road
Tucson, AZ 85716-1910
Phone (520) 322-6274
Other providers in Tucson, AZ
- Virginia Anne Boland-Robillard
- Andria Rae Boland
- Kevin Bolanos
- Brenda Marie Boldrey
- Patricia Bolhack
- Misty Boling
- Mary E Boll
- Theodore J Bollard
- Carol Ann Bolling
- Efua H. Bolouvi
All providers in Tucson, AZ · Geriatric Medicine (Internal Medicine) Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.