Provider Demographics
NPI:1790889319
Name:CLM MEDICAL MANAGEMENT PLC
Entity Type:Organization
Organization Name:CLM MEDICAL MANAGEMENT PLC
Other - Org Name:DESERT FOOTHILLS MEDICAL CENTER LAB AND URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:CHATTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD MS
Authorized Official - Phone:480-488-9220
Mailing Address - Street 1:PO BOX 5925
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-5925
Mailing Address - Country:US
Mailing Address - Phone:480-488-9220
Mailing Address - Fax:480-488-7014
Practice Address - Street 1:36889 N TOM DARLINGTON DR
Practice Address - Street 2:SUITE A4
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377-5925
Practice Address - Country:US
Practice Address - Phone:480-488-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC3627OtherAZ DEPT OF HEALTH SERVICE
C99260Medicare UPIN
AZ1790889319Medicare PIN
Z69954Medicare ID - Type Unspecified
Z69956Medicare ID - Type Unspecified