Healthcare Provider Details

I. General information

NPI: 1306600978
Provider Name (Legal Business Name): PURE HEALTHCARE OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD STE 301
GILBERT AZ
85295-3203
US

IV. Provider business mailing address

4179 S RIVERBOAT RD STE 220
TAYLORSVILLE UT
84123-2986
US

V. Phone/Fax

Practice location:
  • Phone: 480-806-2100
  • Fax:
Mailing address:
  • Phone: 801-921-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA T TANDY
Title or Position: OWNER
Credential:
Phone: 801-787-0731