MEDICARE: NEXTCARE ARIZONA II JV 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1366213225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXTCARE ARIZONA II JV LLC

Provider Business Mailing Address
First Line	:	2145 E BASELINE RD STE 101
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1546
Country	:	US
Telephone Number	:	888-705-8558
Fax Number	:	480-776-0025

Provider Business Practice Location Address
First Line	:	2145 E BASELINE RD STE 104
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1546
Country	:	US
Telephone Number	:	480-704-4411
Fax Number	:	480-704-4735

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MIKHAIL GORBATENKO
Credential	:
Telephone Number	:	972-835-8923

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	01/10/2024

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