MEDICARE: GREENWAY URGENT CARE 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	OTC3147	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CK7981	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629034210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWAY URGENT CARE LLC

Provider Business Mailing Address
First Line	:	1710 THISTLE RD
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-7739
Country	:	US
Telephone Number	:	928-522-8006
Fax Number	:	928-522-8556

Provider Business Practice Location Address
First Line	:	3229 E GREENWAY RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4508
Country	:	US
Telephone Number	:	480-776-1588
Fax Number	:	602-788-3284

Authorized Official
Title or Position	:	CEO
Name	:	DR. JOHN SHUFELDT JR.
Credential	:	M.D
Telephone Number	:	480-924-8382

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	01/24/2008

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Directions to “GREENWAY URGENT CARE LLC ” Practice Location

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