Basic Information
| Provider Information | |||||||||
| NPI: | 1821314998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHISPERING PALMS MEDICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 W INDIAN SCHOOL RD | ||||||||
| Address2: | STE B | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027735600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1108 W INDIAN SCHOOL RD | ||||||||
| Address2: | STE B | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027735600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2010 | ||||||||
| LastUpdateDate: | 10/24/2011 | ||||||||
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| AuthorizedOfficialLastName: | VAID | ||||||||
| AuthorizedOfficialFirstName: | SHALLU | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6235234667 | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | Z139130 | 01 | AZ | MEDICARE PTAN | OTHER |