# MEDICINE MAN INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659083178
- **Authorized official:** DR. MICAH HALE DO (PRESIDENT)
- **Authorized official phone:** (623) 246-4900

## Contact information

- **Practice address:** 9700 N 91ST ST STE A115, SCOTTSDALE, AZ 85258-5036
- **Practice address phone:** (623) 246-4900
- **Mailing address:** 9700 N 91ST ST STE A115, SCOTTSDALE, AZ 85258-5036
- **Mailing address phone:** (623) 246-4900
- **Mailing address fax:** (623) 288-1103

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QC1500X | Community Health Clinic/Center | — | NULL | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |
| 276400000X | Substance Use Disorder Rehabilitation Hospital Unit | — | NULL | — |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |
| 333300000X | Emergency Response System Companies | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |
| 347C00000X | Private Vehicle | — | NULL | — |

## Other

- **Enumeration date:** 12/15/2022
- **Last updated:** 09/05/2026