Provider Demographics
NPI:1518945120
Name:THIRTY THIRD AVENUE MEDICAL LLC
Entity Type:Organization
Organization Name:THIRTY THIRD AVENUE MEDICAL LLC
Other - Org Name:ADVANCED URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BISKUPSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-433-1822
Mailing Address - Street 1:PO BOX 32950
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064
Mailing Address - Country:US
Mailing Address - Phone:602-433-1822
Mailing Address - Fax:602-246-7060
Practice Address - Street 1:3302 W THOMAS RD
Practice Address - Street 2:#10
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017
Practice Address - Country:US
Practice Address - Phone:602-233-2900
Practice Address - Fax:602-233-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC2674261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ630708Medicaid
AZ630708Medicaid