Healthcare Provider Details

I. General information

NPI: 1093067894
Provider Name (Legal Business Name): EAST VALLEY URGENT CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 W WARNER RD
GILBERT AZ
85233
US

IV. Provider business mailing address

3336 E CHANDLER HEIGHTS RD STE 121
GILBERT AZ
85298
US

V. Phone/Fax

Practice location:
  • Phone: 480-840-3075
  • Fax:
Mailing address:
  • Phone: 480-840-3075
  • Fax: 480-988-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SANDRA GRONBERG
Title or Position: SENIOR EXECUTIVE VP OPERATIONS
Credential:
Phone: 480-840-3075