Provider Demographics
NPI:1821808650
Name:PLACITA MOBILE PRIMARY, LLC
Entity type:Organization
Organization Name:PLACITA MOBILE PRIMARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-904-4274
Mailing Address - Street 1:333 N WILMOT RD STE 340
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2607
Mailing Address - Country:US
Mailing Address - Phone:520-904-4274
Mailing Address - Fax:
Practice Address - Street 1:6303 E TANQUE VERDE RD STE 311
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3857
Practice Address - Country:US
Practice Address - Phone:520-904-4274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty