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General NPI Number Information
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NPI Number | 1508469453
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Entity Type | Organization
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Legal Business Name | IMMACULATE HEART OF MARY FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 11/20/2020
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 2175 N ALMA SCHOOL RD STE 109
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City | CHANDLER
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State | AZ
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Zip | 85224-2878
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Country | US
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Telephone | 480-203-9192
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Fax |
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Provider Business Mailing Address
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Address Line | 5602 S JOLLY ROGER RD
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City | TEMPE
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State | AZ
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Zip | 85283-2121
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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 | EXECUTIVE DIRECTOR
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Name | DR. CHARLES ARMSTRONG
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Credential | DO
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Telephone | 480-203-9192
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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 |
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