Provider Demographics
NPI:1497298178
Name:ARIZONA OCCUPATIONAL MEDICAL CLINICS
Entity Type:Organization
Organization Name:ARIZONA OCCUPATIONAL MEDICAL CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-506-5215
Mailing Address - Street 1:3200 N CENTRAL AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4540 E BASELINE RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4616
Practice Address - Country:US
Practice Address - Phone:562-506-5215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine