1326247339 NPI number — GOOD HEALTH URGENT CARE, PLLC

Table of content: (NPI 1326247339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326247339 NPI number — GOOD HEALTH URGENT CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD HEALTH URGENT 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:
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:
1326247339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 S MILL AVE
Provider Second Line Business Mailing Address:
SUITE 280
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85282-6850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-305-2888
Provider Business Mailing Address Fax Number:
480-305-2889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
287 E. HUNT HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN TAN VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85143-5096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-677-8282
Provider Business Practice Location Address Fax Number:
480-677-8283
Provider Enumeration Date:
07/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZAMANI
Authorized Official First Name:
PAYAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
480-677-8282

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)

  • Identifier: 498938 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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