Provider Demographics
| NPI: | 1295371573 |
|---|---|
| Name: | SIGMA CUTS MEDICAL TRAINING ACADEMY |
| Entity type: | Organization |
| Organization Name: | SIGMA CUTS MEDICAL TRAINING ACADEMY |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR REVENUE CYCLE MANAGEMENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ERIN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | STARK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 928-398-7438 |
| Mailing Address - Street 1: | 334 E HATCHER RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHOENIX |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85020-2536 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-654-2179 |
| Mailing Address - Fax: | 602-654-2141 |
| Practice Address - Street 1: | 334 E HATCHER RD |
| Practice Address - Street 2: | |
| Practice Address - City: | PHOENIX |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85020-2536 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-654-2179 |
| Practice Address - Fax: | 602-654-2141 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | SIGMA CUTS MEDICAL TRAINING ACADAMY |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2019-11-21 |
| Last Update Date: | 2023-03-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | ||
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 261QP3300X | Ambulatory Health Care Facilities | Clinic/Center | Pain | |
| No | 261QV0200X | Ambulatory Health Care Facilities | Clinic/Center | VA | |
| No | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | |
| No | 302R00000X | Managed Care Organizations | Health Maintenance Organization | ||
| No | 102X00000X | Behavioral Health & Social Service Providers | Poetry Therapist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AZ | 51454 | Other | MD LICENSE |
| AZ | FD5697416 | Other | DEA LICENSE |
| AZ | 51454 | Other | MD LICENSE |
| AZ | FD5697416 | Medicaid |
