Provider Demographics
NPI:1154668044
Name:AFC OF PEORIA, PLLC
Entity Type:Organization
Organization Name:AFC OF PEORIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-726-2287
Mailing Address - Street 1:1839 S ALMA SCHOOL RD STE 354
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3028
Mailing Address - Country:US
Mailing Address - Phone:480-726-2287
Mailing Address - Fax:888-316-9272
Practice Address - Street 1:15256 N 75TH AVE
Practice Address - Street 2:STE 360
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4761
Practice Address - Country:US
Practice Address - Phone:623-486-2424
Practice Address - Fax:632-486-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
AZ7045160001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty