Provider Demographics
NPI:1134491210
Name:ULTIMATE INTEGRATED PATIENT CARE PLLC
Entity Type:Organization
Organization Name:ULTIMATE INTEGRATED PATIENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-718-5986
Mailing Address - Street 1:PO BOX 10214
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0214
Mailing Address - Country:US
Mailing Address - Phone:480-718-5986
Mailing Address - Fax:480-664-6813
Practice Address - Street 1:13714 N PLAZA DEL RIO BLVD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4874
Practice Address - Country:US
Practice Address - Phone:480-718-5986
Practice Address - Fax:480-664-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005286311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ456982Medicaid
AZ456982Medicaid
AZZ149422Medicare PIN