Provider Demographics
NPI:1043566748
Name:W.L.M. MEDICAL SERVICES P.C.
Entity Type:Organization
Organization Name:W.L.M. MEDICAL SERVICES P.C.
Other - Org Name:COMMUNITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PFUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-633-6314
Mailing Address - Street 1:3201 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2631
Mailing Address - Country:US
Mailing Address - Phone:602-633-6314
Mailing Address - Fax:602-633-6354
Practice Address - Street 1:3201 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2631
Practice Address - Country:US
Practice Address - Phone:602-633-6314
Practice Address - Fax:602-633-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty