Healthcare Provider Details

I. General information

NPI: 1043276587
Provider Name (Legal Business Name): GLENDALE URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18589 N 59TH AVE STE. 101
GLENDALE AZ
85308-1258
US

IV. Provider business mailing address

1710 THISTLE RD
FLAGSTAFF AZ
86004-7739
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-1588
  • Fax: 602-547-8700
Mailing address:
  • Phone: 928-522-8006
  • Fax: 928-522-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberOTC3473
License Number StateAZ

VIII. Authorized Official

Name: JOHN SHUFELDT
Title or Position: CEO
Credential: M.D.
Phone: 480-924-8382