Provider Demographics
NPI:1447765474
Name:CIRCLE THE CITY
Entity Type:Organization
Organization Name:CIRCLE THE CITY
Other - Org Name:CIRCLE THE CITY FAMILY HEALTH CENTER - UMOM CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-776-0776
Mailing Address - Street 1:300 W CLARENDON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3422
Mailing Address - Country:US
Mailing Address - Phone:602-776-0776
Mailing Address - Fax:602-705-0567
Practice Address - Street 1:3333 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6812
Practice Address - Country:US
Practice Address - Phone:602-776-0776
Practice Address - Fax:602-705-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)