Provider Demographics
NPI:1396777447
Name:ARIZONA FAMILY CARE ASSOCIATES URGENT CARE CLINIC, LLC
Entity type:Organization
Organization Name:ARIZONA FAMILY CARE ASSOCIATES URGENT CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:520-458-4335
Mailing Address - Street 1:6 SOUTH SECOND ST
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-1830
Mailing Address - Country:US
Mailing Address - Phone:520-458-4335
Mailing Address - Fax:520-458-2988
Practice Address - Street 1:302 EL CAMINO REAL
Practice Address - Street 2:SUITE 11CD
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2860
Practice Address - Country:US
Practice Address - Phone:520-458-9644
Practice Address - Fax:520-417-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5382700001332B00000X
207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC1464OtherMEDICARE RAILROAD
AZDC1464OtherMEDICARE RAILROAD