Provider Demographics
NPI:1588044457
Name:FIRST CLASS MEDICAL CENTERS, PC
Entity type:Organization
Organization Name:FIRST CLASS MEDICAL CENTERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-577-9340
Mailing Address - Street 1:2040 W BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2473
Mailing Address - Country:US
Mailing Address - Phone:480-577-9340
Mailing Address - Fax:
Practice Address - Street 1:2040 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2473
Practice Address - Country:US
Practice Address - Phone:480-577-9340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ358212Medicaid
SC2015987OtherCDS
F427208066OtherMEDICARE ID
SC159875Medicaid
SC159875Medicaid
1861455222Medicare NSC
F42720Medicare UPIN
SC159875Medicaid