Provider Demographics
NPI:1649703505
Name:THE NEIGHBORHOOD CHRISTIAN CLINIC, INC
Entity type:Organization
Organization Name:THE NEIGHBORHOOD CHRISTIAN CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-258-6008
Mailing Address - Street 1:1929 W FILLMORE ST
Mailing Address - Street 2:BLDG C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-3812
Mailing Address - Country:US
Mailing Address - Phone:602-258-6008
Mailing Address - Fax:602-258-8388
Practice Address - Street 1:1929 W FILLMORE ST
Practice Address - Street 2:BLDG C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3812
Practice Address - Country:US
Practice Address - Phone:602-258-6008
Practice Address - Fax:602-258-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty