Provider Demographics
NPI:1982750600
Name:FORTY-THIRD MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:FORTY-THIRD MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-463-8533
Mailing Address - Street 1:7725 N 43RD AVE
Mailing Address - Street 2:#111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051
Mailing Address - Country:US
Mailing Address - Phone:623-931-9201
Mailing Address - Fax:623-931-2116
Practice Address - Street 1:7725 N 43RD AVE
Practice Address - Street 2:#111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:623-931-9201
Practice Address - Fax:623-931-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ24934Medicare PIN