Provider Demographics
NPI:1073668125
Name:PARTNERS IN MEDICINE PC
Entity Type:Organization
Organization Name:PARTNERS IN MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-252-6855
Mailing Address - Street 1:1515 N 9TH ST
Mailing Address - Street 2:STE. D
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2523
Mailing Address - Country:US
Mailing Address - Phone:602-252-6855
Mailing Address - Fax:602-252-2223
Practice Address - Street 1:1515 N 9TH ST
Practice Address - Street 2:STE. D
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2523
Practice Address - Country:US
Practice Address - Phone:602-252-6855
Practice Address - Fax:602-252-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCLFXMedicare ID - Type Unspecified
AZW98098Medicare UPIN