Provider Demographics
NPI:1043218787
Name:AUC SURPRISE FAMILY CARE LLC
Entity Type:Organization
Organization Name:AUC SURPRISE FAMILY CARE LLC
Other - Org Name:SURPRISE FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM
Authorized Official - Phone:602-530-6189
Mailing Address - Street 1:5410 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4711
Mailing Address - Country:US
Mailing Address - Phone:602-530-6189
Mailing Address - Fax:602-548-2292
Practice Address - Street 1:14800 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4795
Practice Address - Country:US
Practice Address - Phone:623-889-7199
Practice Address - Fax:623-889-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101005Medicare PIN