1649967647 NPI number — PRIMARY CARE PRACTICE OF ARIZONA, PLLC

Table of content: (NPI 1649967647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649967647 NPI number — PRIMARY CARE PRACTICE OF ARIZONA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE PRACTICE OF ARIZONA, 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:
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:
1649967647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 E WILLIAMS FIELD RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85295-4880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-499-0201
Provider Business Mailing Address Fax Number:
480-499-0203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 S HIGLEY RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85296-4799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-499-0201
Provider Business Practice Location Address Fax Number:
480-499-0203
Provider Enumeration Date:
04/19/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
480-499-0201

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com