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General NPI Number Information
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NPI Number | 1982114385
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 36600 N. PIMA ROAD STE 307
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City | CAREFREE
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State | AZ
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Zip | 85377
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Country | US
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Telephone | 480-280-5085
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Fax |
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Provider Business Mailing Address
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Address Line | 11801 N TATUM BLVD STE 145
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City | PHOENIX
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State | AZ
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Zip | 85028-1613
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH KEARNS
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Credential |
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Telephone | 480-280-5085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 33789
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License Number State | AZ
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