Provider Demographics
NPI:1760587885
Name:PAGE FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:PAGE FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CIRIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-894-2823
Mailing Address - Street 1:5030 S MILL AVE STE D12
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6849
Mailing Address - Country:US
Mailing Address - Phone:480-894-2823
Mailing Address - Fax:480-756-6663
Practice Address - Street 1:5030 S MILL AVE STE D12
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6849
Practice Address - Country:US
Practice Address - Phone:480-894-2823
Practice Address - Fax:480-756-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107519Medicare PIN