Provider Demographics
NPI:1952403834
Name:STATCLINIX PLC
Entity Type:Organization
Organization Name:STATCLINIX PLC
Other - Org Name:STATCLINIX - MESA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RN
Authorized Official - Phone:480-516-7058
Mailing Address - Street 1:9382 E BAHIA DR
Mailing Address - Street 2:SUITE B103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1579
Mailing Address - Country:US
Mailing Address - Phone:480-682-4118
Mailing Address - Fax:480-374-7301
Practice Address - Street 1:1151 N GILBERT RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5127
Practice Address - Country:US
Practice Address - Phone:480-610-0688
Practice Address - Fax:480-969-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3604261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ933996Medicaid
AZZ78468Medicare PIN
AZ78468Medicare UPIN