Provider Demographics
NPI:1649926536
Name:FOUNTAIN HILLS PRIMARY CARE LLC
Entity type:Organization
Organization Name:FOUNTAIN HILLS PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-626-9578
Mailing Address - Street 1:16857 E SAGUARO BLVD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6616
Mailing Address - Country:US
Mailing Address - Phone:480-626-9578
Mailing Address - Fax:920-214-1167
Practice Address - Street 1:16857 E SAGUARO BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6616
Practice Address - Country:US
Practice Address - Phone:480-626-9578
Practice Address - Fax:920-214-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care