Provider Demographics
NPI:1700212826
Name:MICHAEL T MEDCHILL, MD, PC
Entity Type:Organization
Organization Name:MICHAEL T MEDCHILL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDCHILL
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:602-264-1771
Mailing Address - Street 1:PO BOX 51180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85076-1180
Mailing Address - Country:US
Mailing Address - Phone:602-264-1771
Mailing Address - Fax:602-264-1661
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:SUITE 480
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-264-1771
Practice Address - Fax:602-264-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20807261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115156Medicaid
AZ115156Medicaid