Provider Demographics
NPI:1457591026
Name:FOOTHILLS FAMILY CARE PLC
Entity type:Organization
Organization Name:FOOTHILLS FAMILY CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-785-4775
Mailing Address - Street 1:4530 E RAY RD
Mailing Address - Street 2:STE 150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6097
Mailing Address - Country:US
Mailing Address - Phone:480-785-4775
Mailing Address - Fax:
Practice Address - Street 1:4530 E RAY RD
Practice Address - Street 2:STE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6097
Practice Address - Country:US
Practice Address - Phone:480-785-4775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ129625Medicare PIN