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General NPI Number Information
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NPI Number | 1417652454
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Entity Type | Organization
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Legal Business Name | POPHEALTHCARE MEDICAL SERVICES OF AZ, PC
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Dates
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Enumeration Date | 03/31/2023
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 1438 W BROADWAY RD STE 101
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City | TEMPE
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State | AZ
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Zip | 85282-1173
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Country | US
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Telephone | 877-358-8109
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Fax |
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Provider Business Mailing Address
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Address Line | 113 SEABOARD LN STE 200B
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City | FRANKLIN
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State | TN
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Zip | 37067-8282
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Country | US
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Telephone | 800-793-7050
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Fax |
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Authorized Official
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Title or Position | MANAGER, CREDENTIALING & LICENSING
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Name | SUSAN PORTER
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Credential |
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Telephone | 615-630-0988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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