Provider Demographics
NPI:1942607296
Name:QUIGLEY FAMILY MEDICAL, LLC
Entity Type:Organization
Organization Name:QUIGLEY FAMILY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:480-347-6474
Mailing Address - Street 1:3055 N RED MTN
Mailing Address - Street 2:101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 S IRONWOOD DR
Practice Address - Street 2:104
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-6242
Practice Address - Country:US
Practice Address - Phone:480-982-1265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4985261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty