Healthcare Provider Details

I. General information

NPI: 1144730607
Provider Name (Legal Business Name): ATLAS MEDICAL SYSTEMS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 N 3RD AVE
PHOENIX AZ
85013-4304
US

IV. Provider business mailing address

PO BOX 32990
PHOENIX AZ
85064-2990
US

V. Phone/Fax

Practice location:
  • Phone: 480-588-3165
  • Fax: 480-588-3169
Mailing address:
  • Phone: 480-588-3165
  • Fax: 480-588-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ATLAS MEDICAL
Title or Position: ATLAS MEDICAL
Credential:
Phone: 480-588-3165