Basic Information
| Provider Information | |||||||||
| NPI: | 1649578014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM C SCIBETTA MD PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36680 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850676680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022341803 | ||||||||
| FaxNumber: | 6022343748 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W CLARENDON AVE | ||||||||
| Address2: | SUITE 142 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022341803 | ||||||||
| FaxNumber: | 6022343748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2011 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | SCIBETTA | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | CRAIG | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6022341803 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.