Organization Name: | AVONDALE URGENT CARE LLC |
NPI Number: | 1134185671 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN SHUFELDT (CEO) |
Mailing Address: | 13075 W Mcdowell Rd Avondale |
State: | AZ US |
Postal Code: | 853236437 |
Phone Number: | 4807761588 |
Fax Number: | 6235470521 |
NPI Enumeration Date: | 04/25/2006 |
NPI Last Update Date: | 01/24/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | OTC3433 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |