MEDICARE: CIRCLE THE CITY

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	:	1497260426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLE THE CITY

Provider Business Mailing Address
First Line	:	300 W CLARENDON AVE STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3422
Country	:	US
Telephone Number	:	602-776-0776
Fax Number	:	602-705-0567

Provider Business Practice Location Address
First Line	:	1125 W JACKSON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-3110
Country	:	US
Telephone Number	:	602-776-0776
Fax Number	:	602-705-0567

Authorized Official
Title or Position	:	CEO
Name	:	BRANDON CLARK
Credential	:
Telephone Number	:	602-776-0776

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	12/13/2017

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Directions to “CIRCLE THE CITY ” Practice Location

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