Provider Demographics
NPI:1508041484
Name:ACUTE CARE SPECIALIST, LLC
Entity Type:Organization
Organization Name:ACUTE CARE SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WAKELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-448-6131
Mailing Address - Street 1:4410 W. UNION HILLS
Mailing Address - Street 2:# 7, PMB 280
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1169
Mailing Address - Country:US
Mailing Address - Phone:623-974-6611
Mailing Address - Fax:623-974-9434
Practice Address - Street 1:10401 W THUNDERBIRD BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3004
Practice Address - Country:US
Practice Address - Phone:623-974-6611
Practice Address - Fax:623-974-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ171322Medicaid
AZZ120465Medicaid
AZ171322Medicaid