MEDICARE: CALLED TO CARE MEDICAL CENTER 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1790224269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALLED TO CARE MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	3301 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7302
Country	:	US
Telephone Number	:	602-885-7535
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7302
Country	:	US
Telephone Number	:	602-885-7535
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. OSAGINWEN KINGSLEY AYIYI
Credential	:	FNP-C
Telephone Number	:	602-885-7535

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	02/16/2017

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