Provider Demographics
NPI:1992353312
Name:AZ PREMIER MOBILE PROVIDERS
Entity type:Organization
Organization Name:AZ PREMIER MOBILE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/ BILLING
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-761-5956
Mailing Address - Street 1:30 N GOULD ST STE R
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2737 E ARIZONA BILTMORE CIR UNIT 30
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2170
Practice Address - Country:US
Practice Address - Phone:602-329-5743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty