1184874414 NPI number — CAMBRIDGE MEDICAL CENTER URGENT CARE

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 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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