MEDICARE: UNITY HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1235707910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITY HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	17425 W HOLLAND LN # SURPRISE
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85388-7865
Country	:	US
Telephone Number	:	602-327-6604
Fax Number	:

Provider Business Practice Location Address
First Line	:	12630 N 103RD AVE # 211-212
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3423
Country	:	US
Telephone Number	:	602-598-0753
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. JULIA B IDEMUDIA
Credential	:	FNP-C
Telephone Number	:	602-327-6604

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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