Healthcare Provider Details

I. General information

NPI: 1912437211
Provider Name (Legal Business Name): BLUE HILLS QUICK CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N WHITE MOUNTAIN RD STE E
SHOW LOW AZ
85901
US

IV. Provider business mailing address

2209 W IRVINE RD
PHOENIX AZ
85086-9110
US

V. Phone/Fax

Practice location:
  • Phone: 480-886-4466
  • Fax:
Mailing address:
  • Phone: 480-886-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: HOLLY ENGELMAN
Title or Position: OWNER/FNP
Credential: FNP
Phone: 480-886-4466