Provider Demographics
NPI:1083347702
Name:CAL-X FAMILY CLINIC PLC
Entity Type:Organization
Organization Name:CAL-X FAMILY CLINIC PLC
Other - Org Name:CALHEALTH FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEKOYA
Authorized Official - Middle Name:MOSELINE
Authorized Official - Last Name:CALIXTE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:602-617-9774
Mailing Address - Street 1:955 N MCQUEEN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8129
Mailing Address - Country:US
Mailing Address - Phone:602-617-9774
Mailing Address - Fax:
Practice Address - Street 1:955 N MCQUEEN RD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8129
Practice Address - Country:US
Practice Address - Phone:602-617-9774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ159554OtherAHCCCS