Healthcare Provider Details

I. General information

NPI: 1225770456
Provider Name (Legal Business Name): ALPHAMED CHANDLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 S ARIZONA AVE STE 4
CHANDLER AZ
85248-4619
US

IV. Provider business mailing address

4949 S ARIZONA AVE STE 4
CHANDLER AZ
85248-4619
US

V. Phone/Fax

Practice location:
  • Phone: 480-847-2225
  • Fax:
Mailing address:
  • Phone: 480-847-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATT OVERLIN
Title or Position: OWNER/PROVIDER
Credential: PA-C
Phone: 602-689-9588