=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881883569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE GARVIN GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2007
-----------------------------------------------------
Last Update Date | 10/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2435 E SOUTHERN AVE SUITE 5
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-7628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-345-6800
-----------------------------------------------------
Fax | 480-345-6805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2435 E SOUTHERN AVE SUITE 5
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-7628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-345-6800
-----------------------------------------------------
Fax | 480-345-6805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. J MICHAEL SUAREZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 480-345-6800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | OTC-2463
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------