Provider Demographics
NPI:1629321302
Name:CAROLYN B PACE MD PC
Entity Type:Organization
Organization Name:CAROLYN B PACE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-456-6561
Mailing Address - Street 1:2600 E SOUTHERN AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7610
Mailing Address - Country:US
Mailing Address - Phone:480-456-6561
Mailing Address - Fax:480-491-3500
Practice Address - Street 1:2600 E SOUTHERN AVE
Practice Address - Street 2:SUITE K
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7610
Practice Address - Country:US
Practice Address - Phone:480-456-6561
Practice Address - Fax:480-491-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22677261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMD22677Medicare PIN