Arizona Skin and Laser Therapy Institute, LTD
Organization Active NPI Dermatology Physician · Coolidge, AZ
NPI 1902355720 · NPPES record last updated Sep 22, 2016
Key facts
- NPI
- 1902355720
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD
- Practice address
- 153 N Central Ave
Coolidge, AZ 85128-4405 - Phone
- (520) 723-8182
- Fax
- (520) 723-9172
- NPI assigned
- Sep 22, 2016
- Organization subpart
- No
Authorized official
- Name
- Neil P Superfon, DO
- Title
- Physician/Owner
- Phone
- (602) 277-2247
Other NPIs on the same Medicare enrollment 9
Corporate family (same tax ID) 2
Practitioners 1
-
Meghan E Day, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040209000424 | AZ | Part B Supplier - Clinic/Group Practice | 6204720626 |
Receives reassigned benefits from 17 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Apache Junction, AZ; Coolidge, AZ; Gilbert, AZ; Mesa, AZ; Phoenix, AZ; Quartzsite, AZ; Scottsdale, AZ; Show Low, AZ |
National Provider Directory
- Tax ID family
- Az Skin Laser Therapy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
153 N Central Ave
Coolidge, AZ 85128-4405
Mailing address
2224 W Northern Ave
Suite D300
Phoenix, AZ 85021-4928
Phone (602) 277-1449
Other providers in Coolidge, AZ
- All Family Dental Care, LLC
- All Hands Medical Transport LLC
- Francisco Amaya-Pinto
- Krysten Arcus
- Arizona Skin and Dermatology PC
- Arizona Training Program @ Coolidge
- Arizona Training Program @ Coolidge
- Arizona Training Program @ Coolidge
- Arizona Training Program @ Coolidge
- Arizona Training Program @ Coolidge
All providers in Coolidge, AZ · Dermatology 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 Sep 22, 2016. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.