Healthcare Provider Details

I. General information

NPI: 1184874414
Provider Name (Legal Business Name): CAMBRIDGE MEDICAL CENTER URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13624 W CAMINO DEL SOL SUITE 100
SUN CITY WEST AZ
85375-3403
US

IV. Provider business mailing address

10645 N TATUM BLVD STE 200623
PHOENIX AZ
85028-3068
US

V. Phone/Fax

Practice location:
  • Phone: 623-214-1717
  • Fax: 623-214-2593
Mailing address:
  • Phone: 602-909-0909
  • Fax: 623-214-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberOTC3840
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIKUE LYNCH
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-707-3312