=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982098406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | URGENT CARE CENTERS OF ARIZONA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2015
-----------------------------------------------------
Last Update Date | 06/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23015 N SCOTTSDALE RD SUITE 101
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-4492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-502-5900
-----------------------------------------------------
Fax | 480-502-6971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23015 N SCOTTSDALE RD SUITE 101
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-4492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-502-5900
-----------------------------------------------------
Fax | 480-502-6971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP, OUTPATIENT SERVICES, TENET
-----------------------------------------------------
Name | MR. MICHAEL KYLE BURTNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-893-2902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------