Provider Demographics
NPI:1316653579
Name:EMINENCE MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:EMINENCE MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHIVERRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-221-2227
Mailing Address - Street 1:2815 S ALMA SCHOOL RD STE 112
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4046
Mailing Address - Country:US
Mailing Address - Phone:602-402-5059
Mailing Address - Fax:623-321-1508
Practice Address - Street 1:2815 S ALMA SCHOOL RD STE 112
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4046
Practice Address - Country:US
Practice Address - Phone:480-221-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty