Healthcare Provider Details

I. General information

NPI: 1326587213
Provider Name (Legal Business Name): ONE HEALTH PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E JEFFERSON ST
PHOENIX AZ
85034-2219
US

IV. Provider business mailing address

901 E JEFFERSON ST
PHOENIX AZ
85034-2219
US

V. Phone/Fax

Practice location:
  • Phone: 602-833-3199
  • Fax: 602-833-3190
Mailing address:
  • Phone: 602-833-3199
  • Fax: 602-833-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROGER FARAHMAND
Title or Position: MANAGER
Credential:
Phone: 214-212-8482