Healthcare Provider Details

I. General information

NPI: 1760884175
Provider Name (Legal Business Name): POPHEALTHCARE MEDICAL SERVICES OF AZ, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 W BROADWAY RD STE 101
TEMPE AZ
85282-1173
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 877-358-8109
  • Fax:
Mailing address:
  • Phone: 180-079-3705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUSAN PORTER
Title or Position: MANAGER, CREDENTIALING & LICENSING
Credential:
Phone: 615-630-0988