Provider Demographics
NPI:1790196806
Name:PRIMARY CARE WALK-IN MEDICAL CLINIC
Entity Type:Organization
Organization Name:PRIMARY CARE WALK-IN MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOPRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-837-4300
Mailing Address - Street 1:16605 E PALISADES BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3716
Mailing Address - Country:US
Mailing Address - Phone:480-837-4300
Mailing Address - Fax:480-837-8302
Practice Address - Street 1:16605 E PALISADES BLVD
Practice Address - Street 2:STE 150
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3716
Practice Address - Country:US
Practice Address - Phone:480-837-4300
Practice Address - Fax:480-837-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ440085Medicaid