Basic Information
| Provider Information | |||||||||
| NPI: | 1487012431 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEXTCARE PRIMARY CARE ARIZONA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 N THUNDERBIRD CIR | ||||||||
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| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852151219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807761600 | ||||||||
| FaxNumber: | 4807761605 | ||||||||
| Practice Location | |||||||||
| Address1: | 474 N HWY 89 | ||||||||
| Address2: | |||||||||
| City: | CHINO VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863235993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807761600 | ||||||||
| FaxNumber: | 4807761605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | MARPLE | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REIMBURSEMENT SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4807761600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.