MEDICARE: MOUNTAIN PARK HEALTH CENTER

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1386452415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN PARK HEALTH CENTER

Provider Business Mailing Address
First Line	:	3003 N CENTRAL AVE STE 1600
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2908
Country	:	US
Telephone Number	:	602-323-3344
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 E BASELINE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6589
Country	:	US
Telephone Number	:	602-243-7277
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JOHN SWAGERT
Credential	:	MD
Telephone Number	:	602-323-3470

Provider Enumeration Date	:	12/20/2024
Last Update Date	:	12/20/2024

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Directions to “MOUNTAIN PARK HEALTH CENTER ” Practice Location

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