Healthcare Provider Details

I. General information

NPI: 1225893407
Provider Name (Legal Business Name): ARIZONA MEDICAL CLINIC THOMAS RD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 E THOMAS RD
PHOENIX AZ
85018-7915
US

IV. Provider business mailing address

1847 W HEATHERBRAE DR
PHOENIX AZ
85015-4764
US

V. Phone/Fax

Practice location:
  • Phone: 602-207-8400
  • Fax: 480-588-2855
Mailing address:
  • Phone: 602-274-2100
  • Fax: 602-535-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA SOM
Title or Position: VP
Credential: MD
Phone: 602-274-2100