Provider Demographics
NPI:1477818730
Name:TRI-CITY EXPRESS CARE, PLLC
Entity Type:Organization
Organization Name:TRI-CITY EXPRESS CARE, PLLC
Other - Org Name:FASTMED URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-545-2787
Mailing Address - Street 1:890 W ELLIOT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5102
Mailing Address - Country:US
Mailing Address - Phone:480-545-2787
Mailing Address - Fax:480-545-1434
Practice Address - Street 1:940 E. UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-4278
Practice Address - Country:US
Practice Address - Phone:480-214-0622
Practice Address - Fax:480-361-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207Q00000X
AZOTC5449261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ785835Medicaid
AZZ110443Medicare PIN