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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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