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General NPI Number Information
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NPI Number | 1124482864
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Entity Type | Organization
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Legal Business Name | THE LITTLE CLINIC
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 4204 W CACTUS RD
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City | PHOENIX
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State | AZ
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Zip | 85029
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Country | US
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Telephone | 602-547-5919
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Fax | 602-547-7023
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Provider Business Mailing Address
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Address Line | 4204 W CACTUS RD
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City | PHOENIX
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State | AZ
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Zip | 85029-2924
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Country | US
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Telephone | 602-547-5919
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Fax | 602-547-7023
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Authorized Official
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Title or Position | VP & GENERAL MANAGER
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Name | MR. THOMAS SHELLY
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Credential |
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Telephone | 615-425-4287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP8609
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License Number State | AZ
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