Provider Demographics
NPI:1588281323
Name:PHXCA, INC
Entity type:Organization
Organization Name:PHXCA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MAYO
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:WARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC OM
Authorized Official - Phone:623-242-0541
Mailing Address - Street 1:2333 W MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3806 N 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2016
Practice Address - Country:US
Practice Address - Phone:623-242-0541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty