Provider Demographics
NPI:1750094181
Name:CALL'S COMMUNITY CLINIC, LLC
Entity type:Organization
Organization Name:CALL'S COMMUNITY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:928-536-4322
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-0246
Mailing Address - Country:US
Mailing Address - Phone:928-536-4322
Mailing Address - Fax:928-536-2395
Practice Address - Street 1:815 MAIN STREET SUITE D
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:AZ
Practice Address - Zip Code:85939
Practice Address - Country:US
Practice Address - Phone:928-536-4322
Practice Address - Fax:928-536-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ546187Medicaid