Healthcare Provider Details

I. General information

NPI: 1508292970
Provider Name (Legal Business Name): UCR HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 S ALMA SCHOOL RD STE 2
CHANDLER AZ
85286-4405
US

IV. Provider business mailing address

2745 S ALMA SCHOOL RD STE 2
CHANDLER AZ
85286-4405
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-7585
  • Fax:
Mailing address:
  • Phone: 480-855-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4509
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL AHMANN
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 480-855-7585