MEDICARE: MEDICAL CLINIC OF ARIZONA, 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1629490149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CLINIC OF ARIZONA, LLC

Provider Business Mailing Address
First Line	:	6025 N 27TH AVE
Second Line	:	SUITE# 6
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1763
Country	:	US
Telephone Number	:	602-841-8273
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 N 27TH AVE
Second Line	:	SUITE# 6
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1763
Country	:	US
Telephone Number	:	602-841-8273
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALMA S BELTRAN
Credential	:
Telephone Number	:	480-289-8464

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	01/17/2014

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