Provider Demographics
NPI:1346499324
Name:CENTURY CARE INC
Entity Type:Organization
Organization Name:CENTURY CARE INC
Other - Org Name:ATLAS MEDICAL ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-868-9650
Mailing Address - Street 1:7227 E BASELINE RD STE 126
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-5006
Mailing Address - Country:US
Mailing Address - Phone:480-868-9650
Mailing Address - Fax:480-834-3606
Practice Address - Street 1:7227 E BASELINE RD STE 126
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-5006
Practice Address - Country:US
Practice Address - Phone:480-868-9650
Practice Address - Fax:480-834-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QA0505X, 207QG0300X, 207QH0002X, 207RG0300X, 207RH0002X
AZ12301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ126031Medicare PIN