Provider Demographics
NPI:1184874414
Name:CAMBRIDGE MEDICAL CENTER URGENT CARE
Entity type:Organization
Organization Name:CAMBRIDGE MEDICAL CENTER URGENT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIKUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-707-3312
Mailing Address - Street 1:10645 N TATUM BLVD STE 200623
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3068
Mailing Address - Country:US
Mailing Address - Phone:602-909-0909
Mailing Address - Fax:623-214-2593
Practice Address - Street 1:13624 W CAMINO DEL SOL
Practice Address - Street 2:SUITE 100
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-3403
Practice Address - Country:US
Practice Address - Phone:623-214-1717
Practice Address - Fax:623-214-2593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMBRIDGE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0200X, 207RP1001X
AZOTC3840261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ87026Medicaid