Provider Demographics
NPI:1811248768
Name:PEORIA URGENT CARE CENTER,LLC
Entity type:Organization
Organization Name:PEORIA URGENT CARE CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-877-0100
Mailing Address - Street 1:8914 N 91ST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8390
Mailing Address - Country:US
Mailing Address - Phone:623-877-0100
Mailing Address - Fax:623-298-0656
Practice Address - Street 1:8914 N 91ST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8390
Practice Address - Country:US
Practice Address - Phone:623-877-0100
Practice Address - Fax:623-298-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center