MEDICARE: PRIMARY CARE COMMUNITY HEALTH 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1811842719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE COMMUNITY HEALTH LLC

Provider Business Mailing Address
First Line	:	6025 N 27TH AVE
Second Line	:	STE 5,6,7,8
City	:	PHOENIX
State	:	AZ
Zip	:	85017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 N 27TH AVE
Second Line	:	STE 5,6,7,8
City	:	PHOENIX
State	:	AZ
Zip	:	85017
Country	:	US
Telephone Number	:	602-706-7998
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDRE DREVAL
Credential	:
Telephone Number	:	602-400-2800

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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