Provider Demographics
NPI:1821293580
Name:GENERATIONS FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:GENERATIONS FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-537-5170
Mailing Address - Street 1:13945 W GRAND AVE
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2437
Mailing Address - Country:US
Mailing Address - Phone:623-537-5170
Mailing Address - Fax:623-537-5274
Practice Address - Street 1:13945 W GRAND AVE
Practice Address - Street 2:SUITE A-101
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2437
Practice Address - Country:US
Practice Address - Phone:623-537-5170
Practice Address - Fax:623-537-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3874305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ954140Medicaid
AZ2Z1716OtherHEALTH NET
AZ7039717OtherAETNA
AZAZ0442900OtherBCBS
AZ1659334779Medicare NSC
AZ7039717OtherAETNA
AZ954140Medicaid
AZ1821293580Medicare Oscar/Certification
AZ103746Medicare PIN
AZ2Z1716OtherHEALTH NET
AZ1821293580Medicare NSC