Organization
KIC SCOTTSDALE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHALLEN WAYCHOFF III (COO/MANAGER)
(480) 634-6400
Entity
Organization
Contact information
Practice address
10555 N 114TH ST STE 105, SCOTTSDALE, AZ 85259-4940
(480) 634-6400
(480) 404-9649
Mailing address
3724 N 3RD ST STE 301, PHOENIX, AZ 85012-2035
(480) 634-6400
(480) 404-9649
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
12/19/2018
Last updated
11/19/2019
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