Provider Demographics
NPI:1659153195
Name:GMC HEALTHCARE PLLC
Entity type:Organization
Organization Name:GMC HEALTHCARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:V
Authorized Official - Last Name:MALLARI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-BC
Authorized Official - Phone:602-908-8580
Mailing Address - Street 1:10250 N 124TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5201
Mailing Address - Country:US
Mailing Address - Phone:602-603-4660
Mailing Address - Fax:602-860-6050
Practice Address - Street 1:10250 N 124TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5201
Practice Address - Country:US
Practice Address - Phone:602-603-4660
Practice Address - Fax:602-860-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
03D2299517OtherCLIA
AZ205177Medicaid