Provider Demographics
NPI:1538177449
Name:EAST VALLEY PRIMARY CARE PHYSICIANS PLC
Entity type:Organization
Organization Name:EAST VALLEY PRIMARY CARE PHYSICIANS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-820-1133
Mailing Address - Street 1:4515 S MCCLINTOCK DR
Mailing Address - Street 2:#100
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7376
Mailing Address - Country:US
Mailing Address - Phone:480-820-1133
Mailing Address - Fax:
Practice Address - Street 1:4515 S MCCLINTOCK DR
Practice Address - Street 2:#100
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7376
Practice Address - Country:US
Practice Address - Phone:480-820-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ23664Medicare ID - Type Unspecified