Healthcare Provider Details

I. General information

NPI: 1366716557
Provider Name (Legal Business Name): TRI-CITY EXPRESS CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 W HAPPY VALLEY RD SUITE 100
GLENDALE AZ
85310-3282
US

IV. Provider business mailing address

890 W ELLIOT RD SUITE 103
GILBERT AZ
85233-5102
US

V. Phone/Fax

Practice location:
  • Phone: 623-277-4140
  • Fax: 623-547-5880
Mailing address:
  • Phone: 480-545-2787
  • Fax: 480-545-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberOTC5349
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL P DUNN
Title or Position: CMO
Credential: MD
Phone: 480-545-2787