Provider Demographics
NPI:1619188778
Name:GLOBE FAMILY MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:GLOBE FAMILY MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-425-5651
Mailing Address - Street 1:HC 2 BOX 3
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9773
Mailing Address - Country:US
Mailing Address - Phone:928-425-5651
Mailing Address - Fax:928-425-9644
Practice Address - Street 1:2005 HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9601
Practice Address - Country:US
Practice Address - Phone:928-425-5651
Practice Address - Fax:928-425-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ178899Medicaid
AZF52807Medicare UPIN
AZZ61079Medicare PIN