Provider Demographics
NPI:1033307715
Name:AMERICAN CURRENT CARE OF ARIZONA PA
Entity Type:Organization
Organization Name:AMERICAN CURRENT CARE OF ARIZONA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP / CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-232-3550
Mailing Address - Street 1:5080 SPECTRUM DRIVE
Mailing Address - Street 2:SUITE 1200 WEST TOWER
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001
Mailing Address - Country:US
Mailing Address - Phone:800-232-3550
Mailing Address - Fax:
Practice Address - Street 1:7400 WEST OLIVE AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345
Practice Address - Country:US
Practice Address - Phone:623-487-8598
Practice Address - Fax:623-487-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ300205Medicaid
AZZ126048Medicare PIN
AZZ120952Medicare PIN