Provider Demographics
NPI:1063682524
Name:JERITY ENTERPRISES, LLC
Entity Type:Organization
Organization Name:JERITY ENTERPRISES, LLC
Other - Org Name:MACROTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:SANSTEAD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:602-308-8383
Mailing Address - Street 1:1063 N OPAL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2275
Mailing Address - Country:US
Mailing Address - Phone:602-308-8383
Mailing Address - Fax:480-699-6413
Practice Address - Street 1:14362 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:SUITE B109
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-8846
Practice Address - Country:US
Practice Address - Phone:602-308-8383
Practice Address - Fax:480-699-6413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07625378E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty