Provider Demographics
NPI:1356496020
Name:WEE CARE FAMILY CLINIC CORP
Entity Type:Organization
Organization Name:WEE CARE FAMILY CLINIC CORP
Other - Org Name:WEE CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-244-5373
Mailing Address - Street 1:2017 E ADOBE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-6740
Mailing Address - Country:US
Mailing Address - Phone:480-244-5373
Mailing Address - Fax:480-890-2201
Practice Address - Street 1:2017 E ADOBE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-6740
Practice Address - Country:US
Practice Address - Phone:480-244-5373
Practice Address - Fax:480-890-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115241Medicaid