Healthcare Provider Details

I. General information

NPI: 1649530197
Provider Name (Legal Business Name): TRI-CITY EXPRESS CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 N LITCHFIELD RD
GOODYEAR AZ
85395-1237
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 623-215-0040
  • Fax: 623-535-3397
Mailing address:
  • Phone: 480-545-2787
  • Fax: 480-545-1434

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