Healthcare Provider Details

I. General information

NPI: 1205135969
Provider Name (Legal Business Name): EAST VALLEY CRITICAL CARE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CRISMON RD
MESA AZ
85209-3767
US

IV. Provider business mailing address

6750 E BAYWOOD AVE SUITE 507
MESA AZ
85206-1749
US

V. Phone/Fax

Practice location:
  • Phone: 480-358-6100
  • Fax:
Mailing address:
  • Phone: 480-835-7111
  • Fax: 480-218-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD BASS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 602-717-4751