Provider Demographics
NPI:1255487955
Name:WRIGHT FAMILY MEDICINE, INC
Entity Type:Organization
Organization Name:WRIGHT FAMILY MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LOGAN
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-889-0508
Mailing Address - Street 1:3800 W RAY RD
Mailing Address - Street 2:STE. 21
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5940
Mailing Address - Country:US
Mailing Address - Phone:480-889-0508
Mailing Address - Fax:480-889-0511
Practice Address - Street 1:3800 W RAY RD
Practice Address - Street 2:STE. 21
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5940
Practice Address - Country:US
Practice Address - Phone:480-889-0508
Practice Address - Fax:480-889-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ418170Medicaid
AZG64476Medicare UPIN
AZZ70240Medicare ID - Type Unspecified
AZ418170Medicaid