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Organization
INGENUITY MEDICAL GROUP LLC
Active
Organization
INGENUITY MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK A. SMITH (BUSINESS MANAGER)
(480) 296-6549
Entity
Organization
Contact information
Practice address
1930 E THOMAS RD, PHOENIX, AZ 85016-7711
(480) 296-6549
Mailing address
80 E RIO SALADO PKWY STE 703, TEMPE, AZ 85281-9110
(480) 247-9195
(480) 588-8027
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
763484
—
AZ
Enumeration date
07/03/2006
Last updated
04/20/2008
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