Provider Demographics
NPI:1225275829
Name:PMM HEALTHCARE
Entity Type:Organization
Organization Name:PMM HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE FACILITATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:602-442-4500
Mailing Address - Street 1:4660 W THOMAS RD STE A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-3718
Mailing Address - Country:US
Mailing Address - Phone:602-442-4500
Mailing Address - Fax:602-442-4505
Practice Address - Street 1:4660 W THOMAS RD
Practice Address - Street 2:STE-A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3718
Practice Address - Country:US
Practice Address - Phone:602-442-4500
Practice Address - Fax:602-442-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33819261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care