Healthcare Provider Details

I. General information

NPI: 1649522103
Provider Name (Legal Business Name): WILMONT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N WILMONT ROAD SUITE 110
TUCSON AZ
85712-8403
US

IV. Provider business mailing address

1400 N WILMONT ROAD SUITE 110
TUCSON AZ
85712-8403
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2787
  • Fax:
Mailing address:
  • Phone: 480-545-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRUDY JAMES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 480-545-2787