Provider Demographics
NPI:1811280530
Name:EAST VALLEY PRIMARY CARE, LLC
Entity type:Organization
Organization Name:EAST VALLEY PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KAGIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-736-1777
Mailing Address - Street 1:3035 S ELLSWORTH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2136
Mailing Address - Country:US
Mailing Address - Phone:480-736-1777
Mailing Address - Fax:480-736-1144
Practice Address - Street 1:3035 S ELLSWORTH RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2136
Practice Address - Country:US
Practice Address - Phone:480-736-1777
Practice Address - Fax:480-736-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty