=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700423415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HONORHEALTH URGENT CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2019
-----------------------------------------------------
Last Update Date | 12/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20745 N SCOTTSDALE RD STE 105
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-6453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-587-5520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 W UTOPIA RD STE 100
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85027-4172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-587-5314
-----------------------------------------------------
Fax | 480-882-5874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP
-----------------------------------------------------
Name | SAVAS PETRIDES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-696-4020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------