Provider Demographics
NPI:1659621068
Name:WEST MCDOWELL HEALTH CENTER PLLC
Entity Type:Organization
Organization Name:WEST MCDOWELL HEALTH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-824-4900
Mailing Address - Street 1:5030 W MCDOWELL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85035-3946
Mailing Address - Country:US
Mailing Address - Phone:602-824-4900
Mailing Address - Fax:602-824-4912
Practice Address - Street 1:5030 W MCDOWELL RD STE 6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-3946
Practice Address - Country:US
Practice Address - Phone:602-824-4900
Practice Address - Fax:602-824-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3051261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341735Medicaid