Healthcare Provider Details

I. General information

NPI: 1982952024
Provider Name (Legal Business Name): URBAN LIVESTOCK & EQUINE VETERINARY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 N CENTER ST SUITE 102
MESA AZ
85201-5084
US

IV. Provider business mailing address

744 N CENTER ST SUITE 102
MESA AZ
85201-5084
US

V. Phone/Fax

Practice location:
  • Phone: 480-436-4970
  • Fax: 480-284-5045
Mailing address:
  • Phone: 480-436-4970
  • Fax: 480-284-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6252
License Number StateAZ

VIII. Authorized Official

Name: DR. COLLEEN SHANNON MCCOY
Title or Position: PRESIDENT
Credential: D.V.M.
Phone: 480-436-4970