Provider Demographics
NPI: | 1891014825 |
---|---|
Name: | NEXTCARE ARIZONA LLC |
Entity Type: | Organization |
Organization Name: | NEXTCARE ARIZONA LLC |
Other - Org Name: | NEXTCARE URGENT CARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHUFELDT |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 480-924-8382 |
Mailing Address - Street 1: | 2550 N THUNDERBIRD CIR |
Mailing Address - Street 2: | STE. 303 |
Mailing Address - City: | MESA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85215-1215 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-924-8382 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1701 E THOMAS RD |
Practice Address - Street 2: | STE. A104 |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85016-7646 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-819-8566 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-06-01 |
Last Update Date: | 2010-06-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | OTC3994 | 261QU0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |