Basic Information
| Provider Information | |||||||||
| NPI: | 1770978041 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMPOWER GREEN VALLEY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7332 E BUTHERUS DR HNGR 1 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852608005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803395001 | ||||||||
| FaxNumber: | 4802476482 | ||||||||
| Practice Location | |||||||||
| Address1: | 4455 S. I-19 FRONTAGE ROAD | ||||||||
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| City: | GREENVALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208082382 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | SHUFELDT | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4803395001 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EMPOWER HOLDINGS PLLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.