Healthcare Provider Details

I. General information

NPI: 1407776388
Provider Name (Legal Business Name): FAMILY MEDICAL INTEGRATED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 S WATERBERRY ST
MAYER AZ
86333-2027
US

IV. Provider business mailing address

15029 N THOMPSON PEAK PKWY
SCOTTSDALE AZ
85260-2217
US

V. Phone/Fax

Practice location:
  • Phone: 602-926-2189
  • Fax: 866-205-4076
Mailing address:
  • Phone: 623-210-9045
  • Fax: 602-926-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BROOKE JOHNSTON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 623-210-9045