Healthcare Provider Details

I. General information

NPI: 1477236495
Provider Name (Legal Business Name): PRIMARY CARE PRACTICE OF ARIZONA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25070 S ELLSWORTH RD STE 101
QUEEN CREEK AZ
85142
US

IV. Provider business mailing address

920 E WILLIAMS FIELD RD STE 101
GILBERT AZ
85295-4880
US

V. Phone/Fax

Practice location:
  • Phone: 480-499-0201
  • Fax: 480-499-0203
Mailing address:
  • Phone: 480-499-0201
  • Fax: 480-433-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PATRICK DUNN
Title or Position: MANAGER
Credential:
Phone: 480-448-2411