Provider Demographics
NPI:1407109127
Name:AFC OF AVONDALE, PLLC
Entity Type:Organization
Organization Name:AFC OF AVONDALE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:URISSA
Authorized Official - Middle Name:FRANCILLE
Authorized Official - Last Name:BOLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-726-2287
Mailing Address - Street 1:1839 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 354
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3028
Mailing Address - Country:US
Mailing Address - Phone:480-726-2287
Mailing Address - Fax:888-315-4172
Practice Address - Street 1:210 N AVONDALE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-6906
Practice Address - Country:US
Practice Address - Phone:623-882-0600
Practice Address - Fax:623-882-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty