MEDICARE: AZ MOBILE HEALTH 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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1477379964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZ MOBILE HEALTH LLC

Provider Business Mailing Address
First Line	:	4111 N 21ST ST APT 120
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6164
Country	:	US
Telephone Number	:	602-577-1256
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N 1ST AVE STE 2325
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85003-1933
Country	:	US
Telephone Number	:	602-518-5866
Fax Number	:	480-718-8857

Authorized Official
Title or Position	:	OWNER
Name	:	SETH D HANSON
Credential	:	PA-C
Telephone Number	:	602-577-1256

Provider Enumeration Date	:	11/29/2024
Last Update Date	:	01/26/2025

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Directions to “AZ MOBILE HEALTH LLC ” Practice Location

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