Organization
MEDICINE MAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICAH HALE DO (PRESIDENT)
(831) 818-9833
Entity
Organization
Contact information
Practice address
9700 N 91ST ST STE A115, SCOTTSDALE, AZ 85258-5036
(623) 246-4900
Mailing address
27418 N 93RD ST, SCOTTSDALE, AZ 85262-9015
(623) 439-8620
(480) 806-2832
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
333300000X
Emergency Response System Companies
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
12/15/2022
Last updated
08/28/2023
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