Provider Demographics
NPI:1689224057
Name:PERRON MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PERRON MEDICAL CENTER, LLC
Other - Org Name:ADVANCED BACK & NECK CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:PERRON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-688-2246
Mailing Address - Street 1:1055 W QUEEN CREEK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-8134
Mailing Address - Country:US
Mailing Address - Phone:480-814-7792
Mailing Address - Fax:
Practice Address - Street 1:1055 W QUEEN CREEK RD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-8134
Practice Address - Country:US
Practice Address - Phone:480-814-7792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty