Provider Demographics
NPI:1730353046
Name:JOHN PRIEVE DO A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JOHN PRIEVE DO A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIEVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-973-2712
Mailing Address - Street 1:8509 N 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4919
Mailing Address - Country:US
Mailing Address - Phone:602-973-2712
Mailing Address - Fax:602-841-3218
Practice Address - Street 1:8509 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4919
Practice Address - Country:US
Practice Address - Phone:602-973-2712
Practice Address - Fax:602-841-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26-13939581261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI62402Medicare UPIN