Organization
IM SPECIALIST, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARI CASTLE (PRACTICE MANAGER)
(602) 437-4800
Entity
Organization
Contact information
Practice address
2737 W BASELINE RD, SUITE 24, TEMPE, AZ 85283-1051
(602) 437-4800
(602) 437-4805
Mailing address
2737 W BASELINE RD, SUITE 24, TEMPE, AZ 85283-1051
(602) 437-4800
(602) 437-4805
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25040
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425993
—
AZ
01
—
AZ0767620
BCBS OF AZ
AZ
Enumeration date
05/18/2007
Last updated
01/06/2011
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