Provider Demographics
NPI:1235471095
Name:AFC PHYSICAL MEDICINE OF FOUNTAIN HILLS, PLLC
Entity Type:Organization
Organization Name:AFC PHYSICAL MEDICINE OF FOUNTAIN HILLS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-816-8300
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:17100 E SHEA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6625
Practice Address - Country:US
Practice Address - Phone:480-816-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFC PHYSICAL MEDICINE OF FOUNTAIN HILLS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site