Provider Demographics
NPI:1285305417
Name:CITIZENS INTEGRATED FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:CITIZENS INTEGRATED FAMILY PRACTICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:KIPKORIR
Authorized Official - Last Name:SANG
Authorized Official - Suffix:
Authorized Official - Credentials:AGACNP, FNP
Authorized Official - Phone:480-406-1132
Mailing Address - Street 1:1530 E WILLIAMS FIELD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:288 N IRONWOOD DR STE 112
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3830
Practice Address - Country:US
Practice Address - Phone:515-867-1918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty