MEDICARE: OCCUPATIONAL & URGENT CARE HEALTHCENTERS, 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	261QU0200X	Urgent Care Clinic/Center	OTC3935	AZ

General Provider Information

NPI Number	:	1518389543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL & URGENT CARE HEALTHCENTERS, LLC

Provider Business Mailing Address
First Line	:	3501 W OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85019-4037
Country	:	US
Telephone Number	:	602-272-1162
Fax Number	:	602-773-0287

Provider Business Practice Location Address
First Line	:	177 W COTTONWOOD LN
Second Line	:	SUITE 5
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-2552
Country	:	US
Telephone Number	:	602-272-1162
Fax Number	:	602-773-0287

Authorized Official
Title or Position	:	HR DIRECTOR
Name	:	HEATHER WAHL
Credential	:
Telephone Number	:	602-272-1162

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	01/10/2014

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