Healthcare Provider Details

I. General information

NPI: 1043218787
Provider Name (Legal Business Name): AUC SURPRISE FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 W MOUNTAIN VIEW BLVD SUITE 190
SURPRISE AZ
85374-4795
US

IV. Provider business mailing address

5410 W THUNDERBIRD RD SUITE 101
GLENDALE AZ
85306-4711
US

V. Phone/Fax

Practice location:
  • Phone: 623-889-7199
  • Fax: 623-889-7198
Mailing address:
  • Phone: 602-530-6189
  • Fax: 602-548-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3147
License Number StateAZ

VIII. Authorized Official

Name: MR. BILL EDWARDS
Title or Position: CEO
Credential: MAOM
Phone: 602-530-6189