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

General Provider Information

NPI Number	:	1891132650
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	:	480-545-1434

Provider Business Practice Location Address
First Line	:	5594 E 22ND ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-5523
Country	:	US
Telephone Number	:	520-232-2047
Fax Number	:	520-790-5045

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

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	02/13/2014

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