Provider Demographics
NPI:1730359498
Name:PHYTCARE LLC
Entity type:Organization
Organization Name:PHYTCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:STOIMENOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-924-8382
Mailing Address - Street 1:PO BOX 41007
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-1007
Mailing Address - Country:US
Mailing Address - Phone:800-849-5609
Mailing Address - Fax:910-864-9762
Practice Address - Street 1:2550 N THUNDERBIRD CIR
Practice Address - Street 2:STE 303
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1215
Practice Address - Country:US
Practice Address - Phone:800-849-5609
Practice Address - Fax:910-864-9762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXTCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-08
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherEIN