Provider Demographics
NPI:1184998908
Name:QUICK CARE EAST VALLEY
Entity type:Organization
Organization Name:QUICK CARE EAST VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-699-4555
Mailing Address - Street 1:7233 E BASELINE RD
Mailing Address - Street 2:STE 127
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-5007
Mailing Address - Country:US
Mailing Address - Phone:480-699-4555
Mailing Address - Fax:480-699-3033
Practice Address - Street 1:7233 E BASELINE RD
Practice Address - Street 2:STE 127
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-5007
Practice Address - Country:US
Practice Address - Phone:480-699-4555
Practice Address - Fax:480-699-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36540261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1952380925OtherNPI
AZ569897Medicaid
AZ119260-1215960638OtherMEDICARE PTAN
AZ119260-1215960638OtherMEDICARE PTAN