Healthcare Provider Details

I. General information

NPI: 1609115997
Provider Name (Legal Business Name): TRI-CITY EXPRESS CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 E THUNDERBIRD RD SUITE 73
PHOENIX AZ
85032-5600
US

IV. Provider business mailing address

890 W ELLIOT RD SUITE 103
GILBERT AZ
85233-5102
US

V. Phone/Fax

Practice location:
  • Phone: 623-123-4567
  • Fax: 623-345-6789
Mailing address:
  • Phone: 480-545-2787
  • Fax: 480-545-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL P. DUNN
Title or Position: CMO
Credential: MD
Phone: 480-545-2787