Healthcare Provider Details

I. General information

NPI: 1104302413
Provider Name (Legal Business Name): POPHEALTHCARE MEDICAL SERVICES OF AZ, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W 3RD ST STE 500
TEMPE AZ
85281
US

IV. Provider business mailing address

113 SEABOARD LN STE 200B
FRANKLIN TN
37067-8282
US

V. Phone/Fax

Practice location:
  • Phone: 480-237-5099
  • Fax: 877-358-8109
Mailing address:
  • Phone: 800-793-7050
  • Fax: 877-358-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUSAN PORTER
Title or Position: DIRECTOR
Credential:
Phone: 615-500-2199