Provider Demographics
NPI:1720159841
Name:ARIZONA VISTA FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:ARIZONA VISTA FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF AVFM
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:480-892-1212
Mailing Address - Street 1:875 N GREENFIELD RD
Mailing Address - Street 2:# 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5044
Mailing Address - Country:US
Mailing Address - Phone:480-892-1212
Mailing Address - Fax:480-892-4941
Practice Address - Street 1:875 N GREENFIELD RD
Practice Address - Street 2:# 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5044
Practice Address - Country:US
Practice Address - Phone:480-892-1212
Practice Address - Fax:480-892-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26887207Q00000X
AZ3160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH 51718Medicare UPIN
AZZ76024Medicare PIN