MEDICARE: STETSON HILLS FAMILY MEDICINE PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134437205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STETSON HILLS FAMILY MEDICINE PLC

Provider Business Mailing Address
First Line	:	6520 W HAPPY VALLEY RD
Second Line	:	SUITE B103
City	:	GLENDALE
State	:	AZ
Zip	:	85310-2615
Country	:	US
Telephone Number	:	623-825-3700
Fax Number	:	623-825-7601

Provider Business Practice Location Address
First Line	:	6520 W HAPPY VALLEY RD
Second Line	:	STE B-103
City	:	GLENDALE
State	:	AZ
Zip	:	85310-2615
Country	:	US
Telephone Number	:	623-825-3700
Fax Number	:	623-825-7601

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	EDWARD ARANAS
Credential	:	DO
Telephone Number	:	623-825-3700

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	02/24/2011

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