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General NPI Number Information
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NPI Number | 1740526144
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Entity Type | Organization
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Legal Business Name | TRICITY EXPRESS CARE PLLC
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 12775 W BELL RD SUITE 100
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City | SURPRISE
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State | AZ
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Zip | 85378-9770
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Country | US
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Telephone | 480-545-2787
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Fax | 480-545-1434
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Provider Business Mailing Address
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Address Line | 890 W ELLIOT RD SUITE 103
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City | GILBERT
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State | AZ
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Zip | 85233-5102
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Country | US
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Telephone | 480-545-2787
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Fax | 480-545-1434
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Authorized Official
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Title or Position | CMO
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Name | MICHAEL DUNN
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Credential | MD
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Telephone | 480-545-2787
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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 | OTC5592
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License Number State | AZ
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