Provider Demographics
NPI:1043657893
Name:AZ ALLOPATHIC CARE, LLC
Entity Type:Organization
Organization Name:AZ ALLOPATHIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:INCLEDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD, LD, LN, RPT
Authorized Official - Phone:480-294-0542
Mailing Address - Street 1:8131 E INDIAN BEND RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4822
Mailing Address - Country:US
Mailing Address - Phone:480-294-0542
Mailing Address - Fax:480-883-7241
Practice Address - Street 1:8131 E INDIAN BEND RD
Practice Address - Street 2:SUITE 226
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-4822
Practice Address - Country:US
Practice Address - Phone:480-294-0542
Practice Address - Fax:480-883-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133V00000X
AZ47294208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty