1194052514 NPI number — TRI-CITY EXPRESS CARE, PLLC

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 1194052514 NPI number — TRI-CITY EXPRESS CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-CITY EXPRESS 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:
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:
1194052514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 W ELLIOT RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85233-5102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-545-2787
Provider Business Mailing Address Fax Number:
480-545-1434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2875 W RAY RD
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85224-3619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-899-3070
Provider Business Practice Location Address Fax Number:
480-824-1312
Provider Enumeration Date:
11/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
MEDICAL DIRECTOR/OWNER
Authorized Official Telephone Number:
480-545-2787

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OTC4718 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , with the licence number: OTC4718 , 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: 477121 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com