Healthcare Provider Details

I. General information

NPI: 1053375659
Provider Name (Legal Business Name): APACHE JUNCTION URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W SOUTHERN AVE STE. 1
APACHE JUNCTION AZ
85220-7455
US

IV. Provider business mailing address

1710 THISTLE RD
FLAGSTAFF AZ
86004-7739
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-1588
  • Fax: 480-985-0173
Mailing address:
  • Phone: 928-522-8006
  • Fax: 928-522-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberOTC3083
License Number StateAZ

VIII. Authorized Official

Name: JOHN SHUFELDT JR.
Title or Position: CEO
Credential: M.D.
Phone: 480-924-8382