Provider Demographics
NPI:1134437205
Name:STETSON HILLS FAMILY MEDICINE PLC
Entity type:Organization
Organization Name:STETSON HILLS FAMILY MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARANAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-825-3700
Mailing Address - Street 1:6520 W HAPPY VALLEY RD
Mailing Address - Street 2:SUITE B103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2615
Mailing Address - Country:US
Mailing Address - Phone:623-825-3700
Mailing Address - Fax:623-825-7601
Practice Address - Street 1:6520 W HAPPY VALLEY RD
Practice Address - Street 2:STE B-103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2615
Practice Address - Country:US
Practice Address - Phone:623-825-3700
Practice Address - Fax:623-825-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ557355Medicaid
AZZ141905Medicare PIN