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General NPI Number Information
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NPI Number | 1578028684
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Entity Type | Organization
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Legal Business Name | CAVE CREEK CLINIC, LLC
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Dates
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Enumeration Date | 02/02/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 2920 E MOHAWK LN STE 101
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City | PHOENIX
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State | AZ
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Zip | 85050-4773
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Country | US
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Telephone | 480-401-1555
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Fax | 800-930-4408
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Provider Business Mailing Address
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Address Line | 15029 N THOMPSON PEAK PKWY # B111-438
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2217
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Country | US
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Telephone | 480-401-1555
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Fax | 800-930-4408
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN SHERMAN GILLIAM
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Credential | MD
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Telephone | 480-401-1555
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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