MEDICARE: TRI-CITY EXPRESS CARE, PLLC

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	OTC2700	AZ

General Provider Information

NPI Number	:	1669899209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-CITY EXPRESS CARE, PLLC

Provider Business Mailing Address
First Line	:	890 W ELLIOT RD
Second Line	:	SUITE 103
City	:	GILBERT
State	:	AZ
Zip	:	85233-5102
Country	:	US
Telephone Number	:	480-545-2787
Fax Number	:	919-882-9575

Provider Business Practice Location Address
First Line	:	1804 W ELLIOT RD
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1004
Country	:	US
Telephone Number	:	480-456-0444
Fax Number	:	480-456-0449

Authorized Official
Title or Position	:	PRESIDENT/CMO
Name	:	DR. MICHAEL P DUNN
Credential	:	MD
Telephone Number	:	480-545-2787

Provider Enumeration Date	:	03/20/2014
Last Update Date	:	03/20/2014

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