Provider Demographics
NPI:1376996868
Name:STETSON HILLS FAMILY MEDICINE PLC
Entity Type:Organization
Organization Name:STETSON HILLS FAMILY MEDICINE PLC
Other - Org Name:STETSON HILLS FAMILY MEDICINE-ANTHEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIMKEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-825-3700
Mailing Address - Street 1:6520 W HAPPY VALLEY RD
Mailing Address - Street 2:STE. B-103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2615
Mailing Address - Country:US
Mailing Address - Phone:623-825-3700
Mailing Address - Fax:623-825-7601
Practice Address - Street 1:41125 N DAISY MOUNTAIN DR
Practice Address - Street 2:STE. 109
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-4954
Practice Address - Country:US
Practice Address - Phone:623-594-6866
Practice Address - Fax:623-249-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5368207Q00000X
AZAP8736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ141905Medicare PIN