Healthcare Provider Details

I. General information

NPI: 1619430691
Provider Name (Legal Business Name): FREEDOM MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 E BROADWAY RD STE 105
MESA AZ
85206-1346
US

IV. Provider business mailing address

6497 S TWILIGHT CT
GILBERT AZ
85298-8886
US

V. Phone/Fax

Practice location:
  • Phone: 480-550-6508
  • Fax: 480-272-7023
Mailing address:
  • Phone: 480-550-6508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: VALERIE SHEARMAN GILREATH III
Title or Position: CEO
Credential: DO
Phone: 814-490-1677