Provider Demographics
NPI:1396484762
Name:ARK FAMILY HEALTH NORTH PEORIA PLLC
Entity type:Organization
Organization Name:ARK FAMILY HEALTH NORTH PEORIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRICK
Authorized Official - Middle Name:O
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-234-0166
Mailing Address - Street 1:8514 W DEER VALLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5387
Mailing Address - Country:US
Mailing Address - Phone:623-226-8825
Mailing Address - Fax:
Practice Address - Street 1:8514 W DEER VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5387
Practice Address - Country:US
Practice Address - Phone:623-226-8825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty