Healthcare Provider Details

I. General information

NPI: 1548779986
Provider Name (Legal Business Name): ARIZONA PRIMARY CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 E VALLEY AUTO DR
MESA AZ
85206-4605
US

IV. Provider business mailing address

3117 E HOBART ST
GILBERT AZ
85296-9175
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-0922
  • Fax: 480-539-2888
Mailing address:
  • Phone: 480-982-0922
  • Fax: 480-539-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number51986
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51986
License Number StateAZ

VIII. Authorized Official

Name: CHELSEA ROBERTS
Title or Position: PHYSICIAN
Credential: MD
Phone: 480-982-0922