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General NPI Number Information
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NPI Number | 1619649076
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Entity Type | Organization
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Legal Business Name | PURE HEALTHCARE OF ARIZONA LLC
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 1760 E PECOS RD STE 301
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City | GILBERT
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State | AZ
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Zip | 85295-3203
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Country | US
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Telephone | 801-590-9267
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Fax | 801-880-3566
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Provider Business Mailing Address
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Address Line | 4179 S RIVERBOAT RD STE 220
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-2986
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Country | US
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Telephone | 855-550-3358
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOSHUA TANDY
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Credential |
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Telephone | 801-787-0731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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