Provider Demographics
NPI:1144673229
Name:ARIZONA LS, LLC
Entity type:Organization
Organization Name:ARIZONA LS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INSURANCE DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NONCLERC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-228-6334
Mailing Address - Street 1:99 CHELMSFORD RD
Mailing Address - Street 2:SUITE 8 NORTH
Mailing Address - City:NORTH BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-1350
Mailing Address - Country:US
Mailing Address - Phone:978-244-0411
Mailing Address - Fax:
Practice Address - Street 1:509 S HYDE PARK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2266
Practice Address - Country:US
Practice Address - Phone:813-228-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty