Provider Demographics
NPI:1619045846
Name:CHANDLER VALLEY URGENT CARE CLINIC, INC.
Entity Type:Organization
Organization Name:CHANDLER VALLEY URGENT CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:TIN
Authorized Official - Last Name:TRANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-792-1025
Mailing Address - Street 1:936 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2531
Mailing Address - Country:US
Mailing Address - Phone:480-792-1025
Mailing Address - Fax:480-792-1026
Practice Address - Street 1:936 W CHANDLER BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2531
Practice Address - Country:US
Practice Address - Phone:480-792-1025
Practice Address - Fax:480-792-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28539261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ68328Medicare PIN
AZG87355Medicare UPIN