Provider Demographics
NPI:1972762839
Name:TRI-CITY EXPRESS CARE, PLLC
Entity type:Organization
Organization Name:TRI-CITY EXPRESS CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-545-2787
Mailing Address - Street 1:890 W ELLIOT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5102
Mailing Address - Country:US
Mailing Address - Phone:480-545-2787
Mailing Address - Fax:480-545-1434
Practice Address - Street 1:415 N VAL VISTA DR
Practice Address - Street 2:SUITE #101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-7058
Practice Address - Country:US
Practice Address - Phone:480-654-5661
Practice Address - Fax:480-654-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3934207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ451786Medicaid
AZZ110443Medicare PIN