Provider Demographics
NPI:1467653147
Name:ACCESS2CARE FAMILY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:ACCESS2CARE FAMILY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLU
Authorized Official - Middle Name:
Authorized Official - Last Name:ONISILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-690-0510
Mailing Address - Street 1:4607 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4006
Mailing Address - Country:US
Mailing Address - Phone:602-690-0510
Mailing Address - Fax:
Practice Address - Street 1:4607 N 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4006
Practice Address - Country:US
Practice Address - Phone:602-690-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ28624Medicare PIN