Provider Demographics
NPI:1528310968
Name:EAST VALLEY PHYSICIANS GROUP PLLC
Entity type:Organization
Organization Name:EAST VALLEY PHYSICIANS GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MEARS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:623-393-8767
Mailing Address - Street 1:305 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-2405
Mailing Address - Country:US
Mailing Address - Phone:623-393-8767
Mailing Address - Fax:623-393-9115
Practice Address - Street 1:2044 N RECKER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2744
Practice Address - Country:US
Practice Address - Phone:480-924-7632
Practice Address - Fax:480-924-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ93305Medicare PIN