1134398340 NPI number — ARIZONA FAMILY CARE ASSOCIATES URGENT CARE CLINIC, LLC

Table of content: (NPI 1134398340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134398340 NPI number — ARIZONA FAMILY CARE ASSOCIATES URGENT CARE CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA FAMILY CARE ASSOCIATES URGENT CARE CLINIC, 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:
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:
1134398340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 S. 2ND ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIERRA VISTA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85635-1830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-458-4335
Provider Business Mailing Address Fax Number:
520-458-2988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2585 E WILCOX DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-459-8990
Provider Business Practice Location Address Fax Number:
520-452-0379
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
FRED
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
520-458-4335

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5382700001 . This is a "DMEPOS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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