Healthcare Provider Details

I. General information

NPI: 1538530779
Provider Name (Legal Business Name): ARCADIA PHYSICIANS TRAVEL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 E CAMELBACK RD SUITE F-100
PHOENIX AZ
85018-2701
US

IV. Provider business mailing address

4350 E CAMELBACK RD SUITE F-100
PHOENIX AZ
85018-2701
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-8700
  • Fax: 602-325-0133
Mailing address:
  • Phone: 602-955-8700
  • Fax: 602-325-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAZ47542
License Number StateAZ

VIII. Authorized Official

Name: TYLER SOUTHWELL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 602-955-8700