Provider Demographics
NPI:1760656268
Name:MARCMEDICAL OF ARIZONA, LLC
Entity Type:Organization
Organization Name:MARCMEDICAL OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-426-1357
Mailing Address - Street 1:901 E COTTONWOOD LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-2221
Mailing Address - Country:US
Mailing Address - Phone:520-426-1357
Mailing Address - Fax:520-426-1574
Practice Address - Street 1:901 E COTTONWOOD LN
Practice Address - Street 2:SUITE D
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2221
Practice Address - Country:US
Practice Address - Phone:520-426-1357
Practice Address - Fax:520-426-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies