Provider Demographics
NPI:1679756308
Name:LS MEDICAL SPECIALISTS, PLC
Entity type:Organization
Organization Name:LS MEDICAL SPECIALISTS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:480-656-0016
Mailing Address - Street 1:16100 N 71ST ST
Mailing Address - Street 2:#100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2225
Mailing Address - Country:US
Mailing Address - Phone:480-656-0016
Mailing Address - Fax:480-634-1723
Practice Address - Street 1:16100 N 71ST ST
Practice Address - Street 2:#100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2225
Practice Address - Country:US
Practice Address - Phone:480-656-0016
Practice Address - Fax:480-634-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z119110Medicare PIN
D00001Medicare UPIN
Z119109Medicare PIN