Provider Demographics
NPI:1841027695
Name:PRIMARY CARE PRACTICE OF ARIZONA, PLLC
Entity type:Organization
Organization Name:PRIMARY CARE PRACTICE OF ARIZONA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-448-2411
Mailing Address - Street 1:920 E WILLIAMS FIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-4880
Mailing Address - Country:US
Mailing Address - Phone:480-650-8133
Mailing Address - Fax:
Practice Address - Street 1:415 N VAL VISTA DR STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-7059
Practice Address - Country:US
Practice Address - Phone:480-499-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care