MEDICARE: CHC PHOENIX, LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1184104291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHC PHOENIX, LLC

Provider Business Mailing Address
First Line	:	4747 E ELLIOT RD STE 32
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-1630
Country	:	US
Telephone Number	:	480-893-8700
Fax Number	:	602-679-8438

Provider Business Practice Location Address
First Line	:	4747 E ELLIOT RD STE 32
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-1630
Country	:	US
Telephone Number	:	480-893-8700
Fax Number	:	602-679-8438

Authorized Official
Title or Position	:	MANAGER
Name	:	JEFF ALEXANDER
Credential	:
Telephone Number	:	719-964-3284

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	08/17/2020

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Directions to “CHC PHOENIX, LLC ” Practice Location

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