Provider Demographics
NPI:1093760936
Name:ASSOCIATED GERIATRIC CLINICS OF ARIZONA INC
Entity type:Organization
Organization Name:ASSOCIATED GERIATRIC CLINICS OF ARIZONA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-854-9004
Mailing Address - Street 1:5602 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8813
Mailing Address - Country:US
Mailing Address - Phone:480-854-9004
Mailing Address - Fax:480-854-8543
Practice Address - Street 1:5602 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8813
Practice Address - Country:US
Practice Address - Phone:480-854-9004
Practice Address - Fax:480-854-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCHPXMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER