Provider Demographics
NPI:1689868747
Name:PRICE FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:PRICE FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-776-2772
Mailing Address - Street 1:18301 N 79TH AVE
Mailing Address - Street 2:STE C-136
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8463
Mailing Address - Country:US
Mailing Address - Phone:623-776-2772
Mailing Address - Fax:623-776-2666
Practice Address - Street 1:18301 N 79TH AVE
Practice Address - Street 2:STE C-136
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8463
Practice Address - Country:US
Practice Address - Phone:623-776-2772
Practice Address - Fax:623-776-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ501792Medicaid
AZZ136949Medicare PIN