1366716557 NPI number — TRI-CITY EXPRESS CARE PLLC

Table of content: (NPI 1366716557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366716557 NPI number — TRI-CITY EXPRESS CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-CITY EXPRESS CARE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366716557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 W ELLIOT RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85233-5102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-545-2787
Provider Business Mailing Address Fax Number:
480-545-1434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3730 W HAPPY VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85310-3282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-277-4140
Provider Business Practice Location Address Fax Number:
623-547-5880
Provider Enumeration Date:
03/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
480-545-2787

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X , with the licence number: OTC5349 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 683213 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com