Provider Demographics
NPI:1639306731
Name:TOTAL MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:TOTAL MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:Z
Authorized Official - Last Name:QASIMYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-628-3149
Mailing Address - Street 1:5048 W NORTHERN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1558
Mailing Address - Country:US
Mailing Address - Phone:623-435-0190
Mailing Address - Fax:623-435-0193
Practice Address - Street 1:5048 W. NORTHERN AVENUE
Practice Address - Street 2:SUITE 105
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302
Practice Address - Country:US
Practice Address - Phone:623-435-0190
Practice Address - Fax:623-435-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
AZ41474261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ441696Medicaid
AZ441696Medicaid