Organization
THUNDERBIRD ENDOSCOPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY SCHULLER RN (CLINICAL DIRECTOR)
(602) 439-1717
Entity
Organization
Contact information
Practice address
5823 W EUGIE AVE, STE B, GLENDALE, AZ 85304-1276
(602) 439-1717
(602) 938-0292
Mailing address
5823 W EUGIE AVE, STE B, GLENDALE, AZ 85304-1276
(602) 439-1717
(602) 938-0292
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
OSC 2750
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0207240
BLUE CROSS/BLUE SHIELD
AZ
01
—
120130
HEALTHNET
AZ
Enumeration date
05/26/2006
Last updated
08/22/2020
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