Healthcare Provider Details

I. General information

NPI: 1366872756
Provider Name (Legal Business Name): ALLKIDS URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10720 E SOUTHERN AVE STE 112A
MESA AZ
85209-3812
US

IV. Provider business mailing address

1455 S STAPLEY DR STE 1
MESA AZ
85204-5850
US

V. Phone/Fax

Practice location:
  • Phone: 480-633-1111
  • Fax:
Mailing address:
  • Phone: 480-633-1111
  • Fax: 480-633-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DEAN STEPHEN MOUSSER
Title or Position: OWNER
Credential: MD
Phone: 480-832-0480