Provider Demographics
NPI:1730608977
Name:MACH 1 MEDICAL LLC
Entity type:Organization
Organization Name:MACH 1 MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-247-6482
Mailing Address - Street 1:7332 E BUTHERUS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2426
Mailing Address - Country:US
Mailing Address - Phone:480-344-5552
Mailing Address - Fax:
Practice Address - Street 1:3400 E SKY HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-4403
Practice Address - Country:US
Practice Address - Phone:480-344-5552
Practice Address - Fax:480-247-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty