Provider Demographics
NPI:1639638257
Name:MDVIP365
Entity Type:Organization
Organization Name:MDVIP365
Other - Org Name:PRIORITY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:520-689-6814
Mailing Address - Street 1:7620 N HARTMAN LN STE 180
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7485
Mailing Address - Country:US
Mailing Address - Phone:520-689-6814
Mailing Address - Fax:866-740-4777
Practice Address - Street 1:7620 N HARTMAN LN STE 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7485
Practice Address - Country:US
Practice Address - Phone:520-689-6814
Practice Address - Fax:866-740-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty