Healthcare Provider Details

I. General information

NPI: 1376996868
Provider Name (Legal Business Name): STETSON HILLS FAMILY MEDICINE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41125 N DAISY MOUNTAIN DR STE. 109
ANTHEM AZ
85086-4954
US

IV. Provider business mailing address

6520 W HAPPY VALLEY RD STE. B-103
GLENDALE AZ
85310-2615
US

V. Phone/Fax

Practice location:
  • Phone: 623-594-6866
  • Fax: 623-249-4982
Mailing address:
  • Phone: 623-825-3700
  • Fax: 623-825-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5368
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8736
License Number StateAZ

VIII. Authorized Official

Name: ERIC S LIMKEMANN
Title or Position: OWNER
Credential: D.O.
Phone: 623-825-3700