Provider Demographics
NPI:1003111378
Name:ARIZONA GRAND MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:ARIZONA GRAND MEDICAL CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYORAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-820-4709
Mailing Address - Street 1:PO BOX 47729
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-7729
Mailing Address - Country:US
Mailing Address - Phone:623-934-5600
Mailing Address - Fax:623-934-5603
Practice Address - Street 1:3777 CROSSINGS DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7121
Practice Address - Country:US
Practice Address - Phone:928-771-9693
Practice Address - Fax:928-708-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty