Healthcare Provider Details

I. General information

NPI: 1851544456
Provider Name (Legal Business Name): EXTREMITY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N 9TH AVE
PHOENIX AZ
85007-1707
US

IV. Provider business mailing address

1601 N 9TH AVE
PHOENIX AZ
85007-1707
US

V. Phone/Fax

Practice location:
  • Phone: 602-405-5105
  • Fax: 602-391-2110
Mailing address:
  • Phone: 602-405-5105
  • Fax: 602-391-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. IVAN D WALKER
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 602-405-5105