Healthcare Provider Details

I. General information

NPI: 1720649064
Provider Name (Legal Business Name): METRO MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 08/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE STE A105
PHOENIX AZ
85029-4609
US

IV. Provider business mailing address

3201 W PEORIA AVE STE A105
PHOENIX AZ
85029-4609
US

V. Phone/Fax

Practice location:
  • Phone: 480-676-3555
  • Fax: 480-999-4481
Mailing address:
  • Phone: 480-676-3555
  • Fax: 480-999-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW M RHODES
Title or Position: MEMBER
Credential: FNP
Phone: 480-676-3555