Provider Demographics
NPI:1558612473
Name:EAST VALLEY URGENT CARE,LLC
Entity Type:Organization
Organization Name:EAST VALLEY URGENT CARE,LLC
Other - Org Name:URGENT CARE EXTRA-CACTUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR EXECUTIVE VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRONBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-840-3075
Mailing Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 121
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4263
Mailing Address - Country:US
Mailing Address - Phone:480-840-3075
Mailing Address - Fax:
Practice Address - Street 1:7611 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:480-840-3075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ83288Medicare PIN