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General NPI Number Information
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NPI Number | 1093170011
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Entity Type | Organization
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Legal Business Name | CENTER FOR TRANSITIONAL CARE MEDICINE, PLLC
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 2501 E SOUTHERN AVE STE 1
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City | TEMPE
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State | AZ
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Zip | 85282-7669
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Country | US
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Telephone | 480-755-2210
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Fax | 480-755-2364
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Provider Business Mailing Address
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Address Line | 233 E SOUTHERN AVE #27776
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City | TEMPE
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State | AZ
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Zip | 85282-5189
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Country | US
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Telephone | 480-755-2210
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Fax | 480-755-2364
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. EDNA KAST
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Credential | MANAGER
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Telephone | 602-513-6598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 33212
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License Number State | AZ
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