Provider Demographics
NPI:1427172667
Name:PROFESSIONAL MEDICAL CENTER INC.
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-944-4520
Mailing Address - Street 1:601 W HATCHER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-3594
Mailing Address - Country:US
Mailing Address - Phone:602-944-4520
Mailing Address - Fax:602-944-0289
Practice Address - Street 1:601 W HATCHER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-3594
Practice Address - Country:US
Practice Address - Phone:602-944-4520
Practice Address - Fax:602-944-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty