Healthcare Provider Details

I. General information

NPI: 1477095735
Provider Name (Legal Business Name): MCKELLIPS INTERNAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 E MCKELLIPS RD STE 5
MESA AZ
85213-3144
US

IV. Provider business mailing address

13840 N NORTHSIGHT BLVD STE 121
SCOTTSDALE AZ
85260-3665
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-1553
  • Fax: 480-981-2442
Mailing address:
  • Phone: 480-588-6924
  • Fax: 480-634-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37616
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES B EVANS II
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 602-791-9112