Healthcare Provider Details

I. General information

NPI: 1346588316
Provider Name (Legal Business Name): CIRCLE THE CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W INDIAN SCHOOL RD
PHOENIX AZ
85013-3205
US

IV. Provider business mailing address

333 W INDIAN SCHOOL RD
PHOENIX AZ
85013-3205
US

V. Phone/Fax

Practice location:
  • Phone: 602-776-9000
  • Fax:
Mailing address:
  • Phone: 602-776-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUNC5520
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRANDON STEVEN CLARK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-776-9000