Provider Demographics
NPI:1376694612
Name:CREEKER MEDICAL, LLC.
Entity Type:Organization
Organization Name:CREEKER MEDICAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-575-6521
Mailing Address - Street 1:4815 E CAREFREE HWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4717
Mailing Address - Country:US
Mailing Address - Phone:480-575-6521
Mailing Address - Fax:
Practice Address - Street 1:4785 E. COACHWHIP WAY
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-4700
Practice Address - Country:US
Practice Address - Phone:480-575-6521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5725850001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1376694612OtherNPI
AZ=========OtherTAX ID