Provider Demographics
NPI:1770556284
Name:51 MDOS
Entity type:Organization
Organization Name:51 MDOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-CERTIFIED
Authorized Official - Phone:315-784-7473
Mailing Address - Street 1:2353 N 123RD DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-6500
Mailing Address - Country:US
Mailing Address - Phone:623-535-8432
Mailing Address - Fax:
Practice Address - Street 1:51 MDOS
Practice Address - Street 2:PSC 3 BOX 2652
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96266
Practice Address - Country:KR
Practice Address - Phone:315-874-7473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center