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General NPI Number Information
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NPI Number | 1053361782
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Entity Type | Organization
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Legal Business Name | ALLIED FAMILY CARE
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 500 W 10TH PL
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City | MESA
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State | AZ
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Zip | 85201-3298
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Country | US
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Telephone | 480-461-2575
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Fax | 480-649-0994
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Provider Business Mailing Address
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Address Line | 1441 N 12TH ST
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City | PHOENIX
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State | AZ
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Zip | 85006-2837
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | RONALD R BUNNELL
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Credential |
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Telephone | 602-495-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OTC 3572
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License Number State | AZ
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