Provider Demographics
NPI:1659326163
Name:MARICOPA FAMILY HEALTH CENTER LLC
Entity Type:Organization
Organization Name:MARICOPA FAMILY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VEERESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODABAGIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-494-7670
Mailing Address - Street 1:1656 E NIGHTHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-9418
Mailing Address - Country:US
Mailing Address - Phone:520-251-1293
Mailing Address - Fax:
Practice Address - Street 1:44400 W. HONEYCUTT RD.
Practice Address - Street 2:B-101
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239
Practice Address - Country:US
Practice Address - Phone:520-494-7670
Practice Address - Fax:520-836-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty