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General NPI Number Information
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NPI Number | 1407313109
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Entity Type | Organization
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Legal Business Name | AGH MESA LLC
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 1419 W HUNT HWY
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-4603
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Country | US
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Telephone | 480-245-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 1419 W HUNT HWY
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-4603
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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 | PRESIDENT/CEO
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Name | JANE E. HANSON
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Credential |
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Telephone | 480-410-4523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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