Provider Demographics
NPI:1023477916
Name:FOUR SEASONS MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:FOUR SEASONS MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MAXON MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-369-8112
Mailing Address - Street 1:2711 CENTERVILLE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1660
Mailing Address - Country:US
Mailing Address - Phone:602-369-8112
Mailing Address - Fax:
Practice Address - Street 1:19820 N 7TH AVE
Practice Address - Street 2:SUITE 230-D
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4736
Practice Address - Country:US
Practice Address - Phone:602-369-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty