Basic Information
| Provider Information | |||||||||
| NPI: | 1669899209 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRI-CITY EXPRESS CARE, PLLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | FASTMED URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 890 W ELLIOT RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852335102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805452787 | ||||||||
| FaxNumber: | 9198829575 | ||||||||
| Practice Location | |||||||||
| Address1: | 1804 W ELLIOT RD | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852841004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804560444 | ||||||||
| FaxNumber: | 4804560449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2014 | ||||||||
| LastUpdateDate: | 03/20/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CMO | ||||||||
| AuthorizedOfficialTelephone: | 4805452787 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | OTC2700 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.