Healthcare Provider Details

I. General information

NPI: 1942607296
Provider Name (Legal Business Name): QUIGLEY FAMILY MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 04/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S IRONWOOD DR 104
APACHE JUNCTION AZ
85120-6242
US

IV. Provider business mailing address

3055 N RED MTN 101
MESA AZ
85207-1002
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-1265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4985
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberAP4985
License Number StateAZ

VIII. Authorized Official

Name: GERARD QUIGLEY
Title or Position: PROVIDER/OWNER
Credential: FNP-C
Phone: 480-347-6474