Provider Demographics
NPI:1790730778
Name:ADULT MEDICINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:ADULT MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VEERESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODABAGIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-251-1293
Mailing Address - Street 1:1656 E NIGHTHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-9418
Mailing Address - Country:US
Mailing Address - Phone:520-251-1293
Mailing Address - Fax:520-836-4429
Practice Address - Street 1:1800 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-5303
Practice Address - Country:US
Practice Address - Phone:520-316-9486
Practice Address - Fax:520-836-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ103557Medicare PIN