Provider Demographics
NPI:1578685145
Name:CASA GRANDE URGENT CARE
Entity Type:Organization
Organization Name:CASA GRANDE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNESA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ERDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:480-444-6710
Mailing Address - Street 1:2248 E FOX ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5230
Mailing Address - Country:US
Mailing Address - Phone:480-644-9165
Mailing Address - Fax:
Practice Address - Street 1:1676 E MCMURRAY BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-6014
Practice Address - Country:US
Practice Address - Phone:520-376-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1774282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital