MEDICARE: FAMILY MEDICAL WALK IN CENTER PC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1982884185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL WALK IN CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 29211
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85038-9211
Country	:	US
Telephone Number	:	602-273-6770
Fax Number	:	602-889-0489

Provider Business Practice Location Address
First Line	:	8102 E MCDOWELL RD
Second Line	:	SUITE 2A
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-3809
Country	:	US
Telephone Number	:	602-273-6770
Fax Number	:	602-889-0489

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	MOREEN KOPPULA
Credential	:	M.D.
Telephone Number	:	602-273-6770

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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Directions to “FAMILY MEDICAL WALK IN CENTER PC ” Practice Location

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