Healthcare Provider Details

I. General information

NPI: 1639306731
Provider Name (Legal Business Name): TOTAL MEDICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5048 W. NORTHERN AVENUE SUITE 106
GLENDALE AZ
85301
US

IV. Provider business mailing address

5048 W NORTHERN AVE STE 106
GLENDALE AZ
85301-1558
US

V. Phone/Fax

Practice location:
  • Phone: 623-435-0190
  • Fax: 623-435-0193
Mailing address:
  • Phone: 623-435-0190
  • Fax: 623-435-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMAD Z. QASIMYAR
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 703-628-3149