Healthcare Provider Details

I. General information

NPI: 1942024914
Provider Name (Legal Business Name): FREEDOM PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 N PERIMETER DR # 135
SCOTTSDALE AZ
85255-7800
US

IV. Provider business mailing address

17500 N PERIMETER DR # 135
SCOTTSDALE AZ
85255-7800
US

V. Phone/Fax

Practice location:
  • Phone: 480-535-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DIANA SHEEHAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 480-535-6300