Healthcare Provider Details

I. General information

NPI: 1467630012
Provider Name (Legal Business Name): MOUNTAIN PARK HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E BASELINE RD
PHOENIX AZ
85042-6589
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 1600
PHOENIX AZ
85012-2908
US

V. Phone/Fax

Practice location:
  • Phone: 602-323-3435
  • Fax: 602-305-8590
Mailing address:
  • Phone: 602-323-3242
  • Fax: 602-323-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number3254
License Number StateAZ

VIII. Authorized Official

Name: JOHN SWAGERT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 602-323-3470