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General NPI Number Information
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NPI Number | 1407805088
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Entity Type | Organization
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Legal Business Name | 1ST CARE MEDICAL CLINIC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 1635 W GLENDALE AVE
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City | PHOENIX
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State | AZ
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Zip | 85021-8813
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Country | US
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Telephone | 602-544-2273
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Fax | 602-544-3017
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Provider Business Mailing Address
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Address Line | 1635 W GLENDALE AVE
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City | PHOENIX
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State | AZ
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Zip | 85021-8813
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Country | US
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Telephone | 602-544-2273
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Fax | 602-544-3017
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | MR. SHAWN TOLOUI
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Credential | BS
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Telephone | 480-213-9951
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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 |
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License Number State | AZ
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