Provider Demographics
NPI:1972704757
Name:SAN TAN URGENT CARE HEALTH CENTER
Entity Type:Organization
Organization Name:SAN TAN URGENT CARE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-458-5135
Mailing Address - Street 1:21321 E OCOTILLO RD SUITE 118
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-6873
Mailing Address - Country:US
Mailing Address - Phone:480-458-5135
Mailing Address - Fax:
Practice Address - Street 1:21321 E OCOTILLO ROAD
Practice Address - Street 2:SUITE 118
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242
Practice Address - Country:US
Practice Address - Phone:480-458-5135
Practice Address - Fax:480-458-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ117968Medicare PIN