Provider Demographics
NPI:1972657062
Name:ARIZONA WELLNESS MEDICAL, LLC
Entity type:Organization
Organization Name:ARIZONA WELLNESS MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-412-9355
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85380-0279
Mailing Address - Country:US
Mailing Address - Phone:623-412-9355
Mailing Address - Fax:623-412-9356
Practice Address - Street 1:5750 W THUNDERBIRD RD STE E580
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4671
Practice Address - Country:US
Practice Address - Phone:623-412-9355
Practice Address - Fax:623-412-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3991208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty