Provider Demographics
NPI:1154474310
Name:BEST MEDICAL/URGENT CARE LLC
Entity Type:Organization
Organization Name:BEST MEDICAL/URGENT CARE LLC
Other - Org Name:JESSE OWENS URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DANIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-824-4640
Mailing Address - Street 1:325 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6510
Mailing Address - Country:US
Mailing Address - Phone:602-824-4200
Mailing Address - Fax:602-824-4215
Practice Address - Street 1:325 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6510
Practice Address - Country:US
Practice Address - Phone:602-824-4200
Practice Address - Fax:602-824-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29250207Q00000X
AZ2816208000000X
AZOTC0106261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ584533Medicaid
AZAZ0206250OtherBLUE CROSS
AZ146317Medicaid
AZ832205Medicaid
AZAZ0852180OtherBLUE CROSS
AZP0201170OtherBLUE CROSS
AZP0201170OtherBLUE CROSS
AZ146317Medicaid
AZ584533Medicaid