Provider Demographics
NPI:1275801326
Name:MARICOPA FAMILY PRACTICE
Entity Type:Organization
Organization Name:MARICOPA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:520-494-7670
Mailing Address - Street 1:44400 W HONEYCUTT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138
Mailing Address - Country:US
Mailing Address - Phone:520-494-7670
Mailing Address - Fax:520-494-7376
Practice Address - Street 1:44400 W HONEYCUTT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2944
Practice Address - Country:US
Practice Address - Phone:520-494-7670
Practice Address - Fax:520-494-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty