Provider Demographics
NPI:1356614176
Name:ALLEN FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:ALLEN FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-699-2222
Mailing Address - Street 1:7233 E BASELINE RD
Mailing Address - Street 2:STE 126
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-5007
Mailing Address - Country:US
Mailing Address - Phone:480-699-2222
Mailing Address - Fax:480-699-3033
Practice Address - Street 1:7233 E BASELINE RD
Practice Address - Street 2:STE 126
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-5007
Practice Address - Country:US
Practice Address - Phone:480-699-2222
Practice Address - Fax:480-699-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44915208VP0000X, 207LP2900X
AZF07141310363LP2300X
AZ5521363AM0700X
AZ36540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1952380925OtherNATIONAL PROVIDER ID
AZ119260-1215960638OtherMEDICARE PTAN
AZ569897Medicaid
AZ1952380925OtherNATIONAL PROVIDER ID