Provider Demographics
NPI:1912162850
Name:VAN BUREN MEDICINE, LLC
Entity Type:Organization
Organization Name:VAN BUREN MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-278-1351
Mailing Address - Street 1:320 N 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-4220
Mailing Address - Country:US
Mailing Address - Phone:602-278-1351
Mailing Address - Fax:602-278-4057
Practice Address - Street 1:320 N 32ND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-4220
Practice Address - Country:US
Practice Address - Phone:602-278-1351
Practice Address - Fax:602-278-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty