Healthcare Provider Details

I. General information

NPI: 1699307603
Provider Name (Legal Business Name): LEVEL ONE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 W THOMAS RD STE 220
PHOENIX AZ
85037-3382
US

IV. Provider business mailing address

PO BOX 11180
TEMPE AZ
85284-0020
US

V. Phone/Fax

Practice location:
  • Phone: 480-930-4018
  • Fax: 480-930-4018
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICK CRIST
Title or Position: SOLE MEMBER
Credential:
Phone: 480-930-4018