1043218787 NPI number — AUC SURPRISE FAMILY CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043218787 NPI number — AUC SURPRISE FAMILY CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUC SURPRISE FAMILY CARE LLC
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:
1043218787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5410 W THUNDERBIRD RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85306-4711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-530-6189
Provider Business Mailing Address Fax Number:
602-548-2292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14800 W MOUNTAIN VIEW BLVD
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85374-4795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-889-7199
Provider Business Practice Location Address Fax Number:
623-889-7198
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
BILL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
602-530-6189

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  3147 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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