Provider Demographics
NPI:1033523949
Name:ARIZONA PRIMARY CARE PHYSICIANS, LLC
Entity type:Organization
Organization Name:ARIZONA PRIMARY CARE PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BLUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-215-9452
Mailing Address - Street 1:16155 N 83RD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5815
Mailing Address - Country:US
Mailing Address - Phone:623-215-9432
Mailing Address - Fax:602-735-3796
Practice Address - Street 1:5620 W THUNDERBIRD RD
Practice Address - Street 2:SUITE F-1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4636
Practice Address - Country:US
Practice Address - Phone:623-215-9432
Practice Address - Fax:602-735-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDV5855OtherRAILROAD MEDICARE PTAN
AZZ174630OtherMEDICARE PTAN