Healthcare Provider Details

I. General information

NPI: 1235409012
Provider Name (Legal Business Name): TRI-CITY EXPRESS CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 W VALENCIA RD STE 101
TUCSON AZ
85746-6555
US

IV. Provider business mailing address

890 W ELLIOT RD SUITE 103
GILBERT AZ
85233-5102
US

V. Phone/Fax

Practice location:
  • Phone: 520-576-5104
  • Fax: 520-807-7711
Mailing address:
  • Phone: 480-545-2787
  • Fax: 480-545-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberOTC5304
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DUNN
Title or Position: CMO
Credential: MD
Phone: 480-545-2787