Provider Demographics
NPI:1578385308
Name:STEADFAST INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:STEADFAST INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:773-263-8344
Mailing Address - Street 1:15720 N GREENWAY HAYDEN LOOP STE 9
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1796
Mailing Address - Country:US
Mailing Address - Phone:414-405-9634
Mailing Address - Fax:
Practice Address - Street 1:15720 N GREENWAY HAYDEN LOOP STE 9
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1796
Practice Address - Country:US
Practice Address - Phone:414-405-9634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care