Provider Demographics
NPI:1295355881
Name:FHMC OPERATING PC
Entity type:Organization
Organization Name:FHMC OPERATING PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEUME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-671-7981
Mailing Address - Street 1:9700 N SAGUARO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6242
Mailing Address - Country:US
Mailing Address - Phone:602-671-7981
Mailing Address - Fax:602-755-0457
Practice Address - Street 1:9700 N SAGUARO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6242
Practice Address - Country:US
Practice Address - Phone:602-671-7981
Practice Address - Fax:602-755-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ082025Medicaid