1184874414 NPI number — CAMBRIDGE MEDICAL CENTER URGENT CARE

Table of content: (NPI 1184874414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184874414 NPI number — CAMBRIDGE MEDICAL CENTER URGENT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMBRIDGE MEDICAL CENTER URGENT CARE
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:
CAMBRIDGE MEDICAL CENTER URGENT CARE
Provider Other Organization Name Type Code:
3
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:
1184874414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10645 N TATUM BLVD STE 200623
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85028-3068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-909-0909
Provider Business Mailing Address Fax Number:
623-214-2593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13624 W CAMINO DEL SOL
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SUN CITY WEST
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85375-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-214-1717
Provider Business Practice Location Address Fax Number:
623-214-2593
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LYNCH
Authorized Official First Name:
KIKUE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
623-707-3312

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , with the licence number: OTC3840 , 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)

  • Identifier: 87026 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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