Healthcare Provider Details

I. General information

NPI: 1336255264
Provider Name (Legal Business Name): GREENFIELD FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 N. GREENFIELD RD. SUITE 104
MESA AZ
85205
US

IV. Provider business mailing address

1244 N. GREENFIELD RD. SUITE 104
MESA AZ
85205
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-6900
  • Fax: 480-964-6901
Mailing address:
  • Phone: 480-964-6900
  • Fax: 480-964-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2584
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2764
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. CARLA JEAN JENKINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-964-6900