Provider Demographics
NPI:1801490461
Name:ASHLEY CLYDE LLC
Entity type:Organization
Organization Name:ASHLEY CLYDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:623-826-1207
Mailing Address - Street 1:2432 W PEORIA AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4736
Mailing Address - Country:US
Mailing Address - Phone:602-715-8045
Mailing Address - Fax:602-441-4673
Practice Address - Street 1:2432 W PEORIA AVE STE 1200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4736
Practice Address - Country:US
Practice Address - Phone:602-715-8045
Practice Address - Fax:602-441-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine