Healthcare Provider Details
I. General information
NPI: 1437570587
Provider Name (Legal Business Name): MEDI-FIRST MEDICAL CENTER P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/16/2013
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
727 E BETHANY HOME RD SUUITE A-101
PHOENIX AZ
85014-2198
US
IV. Provider business mailing address
727 E BETHANY HOME RD SUUITE A-101
PHOENIX AZ
85014-2198
US
V. Phone/Fax
- Phone: 602-279-2400
- Fax: 602-279-5890
- Phone: 602-279-2400
- Fax: 602-279-5890
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 40886 |
| License Number State | AZ |
VIII. Authorized Official
Name: DR.
XUAN
VU
Title or Position: MEMBER/MANAGER
Credential: M.D.
Phone: 602-770-6305