Provider Demographics
NPI:1780819748
Name:EPANGELIA PROPERTIES, LLC
Entity Type:Organization
Organization Name:EPANGELIA PROPERTIES, LLC
Other - Org Name:ARIZONA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-274-2100
Mailing Address - Street 1:1847 W HEATHERBRAE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-4764
Mailing Address - Country:US
Mailing Address - Phone:602-274-2100
Mailing Address - Fax:
Practice Address - Street 1:1847 W. HEATHERBRAE DRIVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-4764
Practice Address - Country:US
Practice Address - Phone:602-274-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty