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General NPI Number Information
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NPI Number | 1629034210
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Entity Type | Organization
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Legal Business Name | GREENWAY URGENT CARE LLC
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 3229 E GREENWAY RD
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City | PHOENIX
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State | AZ
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Zip | 85032-4508
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Country | US
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Telephone | 480-776-1588
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Fax | 602-788-3284
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Provider Business Mailing Address
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Address Line | 1710 THISTLE RD
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-7739
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Country | US
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Telephone | 928-522-8006
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Fax | 928-522-8556
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN SHUFELDT JR.
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Credential | M.D
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Telephone | 480-924-8382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | OTC3147
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License Number State | AZ
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