Provider Demographics
NPI:1073763496
Name:DUNLAP COMPLETE HEALTHCARE LLC
Entity Type:Organization
Organization Name:DUNLAP COMPLETE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:C
Authorized Official - Last Name:PERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-861-3339
Mailing Address - Street 1:1945 W DUNLAP AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2984
Mailing Address - Country:US
Mailing Address - Phone:602-861-3339
Mailing Address - Fax:602-861-3280
Practice Address - Street 1:1945 W DUNLAP AVE STE 10
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2984
Practice Address - Country:US
Practice Address - Phone:602-861-3339
Practice Address - Fax:602-861-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25790302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71138Medicare PIN
AZG71878Medicare UPIN