Provider Demographics
NPI:1154429694
Name:SALUBRIOUS HEALTH CARE PC
Entity type:Organization
Organization Name:SALUBRIOUS HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:602-242-1221
Mailing Address - Street 1:5501 N 19TH AVE
Mailing Address - Street 2:218
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2450
Mailing Address - Country:US
Mailing Address - Phone:602-242-1221
Mailing Address - Fax:623-915-0280
Practice Address - Street 1:5501 N 19TH AVE
Practice Address - Street 2:218
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2450
Practice Address - Country:US
Practice Address - Phone:602-242-1221
Practice Address - Fax:623-915-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78070Medicare ID - Type Unspecified