Healthcare Provider Details

I. General information

NPI: 1336734946
Provider Name (Legal Business Name): BATES FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E BETHANY HOME RD
PHOENIX AZ
85012-1207
US

IV. Provider business mailing address

520 E BETHANY HOME RD
PHOENIX AZ
85012-1207
US

V. Phone/Fax

Practice location:
  • Phone: 602-726-3301
  • Fax: 602-654-3300
Mailing address:
  • Phone: 602-726-3301
  • Fax: 602-654-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GINA BATES
Title or Position: OWNER
Credential: FNP
Phone: 512-554-4523