Provider Demographics
NPI:1265496863
Name:CASA GRANDE URGENT CARE LLC
Entity Type:Organization
Organization Name:CASA GRANDE URGENT CARE LLC
Other - Org Name:NEXTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUFELDT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:480-924-8382
Mailing Address - Street 1:1710 THISTLE RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7739
Mailing Address - Country:US
Mailing Address - Phone:928-522-8006
Mailing Address - Fax:928-522-8556
Practice Address - Street 1:1729 N TREKELL RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2215
Practice Address - Country:US
Practice Address - Phone:480-776-1588
Practice Address - Fax:520-876-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3029261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ628141Medicaid
AZCJ6934OtherRAILROAD MEDICARE
AZZ68134Medicare PIN