Provider Demographics
NPI:1225356157
Name:CLEARPATH FAMILY HEALTH LTD
Entity Type:Organization
Organization Name:CLEARPATH FAMILY HEALTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:C A
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-819-9608
Mailing Address - Street 1:7725 N 43RD AVE STE 720
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-5772
Mailing Address - Country:US
Mailing Address - Phone:623-207-5465
Mailing Address - Fax:623-207-5405
Practice Address - Street 1:7725 N 43RD AVE STE 720
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5772
Practice Address - Country:US
Practice Address - Phone:623-207-5465
Practice Address - Fax:623-207-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1647261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ24102601Medicaid
Z137678OtherPTAN
Z137678OtherPTAN
AZ455844490Medicare PIN