Provider Demographics
NPI:1346014800
Name:THE SOAR CLINIC LLC
Entity type:Organization
Organization Name:THE SOAR CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:EICH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:801-380-2000
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-0186
Mailing Address - Country:US
Mailing Address - Phone:928-536-4322
Mailing Address - Fax:
Practice Address - Street 1:815 N MAIN ST SUITE D
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:AZ
Practice Address - Zip Code:85939
Practice Address - Country:US
Practice Address - Phone:928-536-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1619221694Medicaid