National Provider Identifier Database

ALTA MEDICAL CLINIC INC OF ARIZONA
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.


Contact Information

ALTA MEDICAL CLINIC INC OF ARIZONA
4742 N 24TH ST STE 300
PHOENIX, AZ85016-9107
Phone: 909-236-0338
Fax:
Website:
Specialty Taxonomy Code
* General Practice 208D00000X
Behavioral Neurology & Neuropsychiatry 2084B0040X

* Indicates primary specialty

NPI Profile & details for ALTA MEDICAL CLINIC INC OF ARIZONA

NPI Number 1679280671
Legal business name
LBN
ALTA MEDICAL CLINIC INC OF ARIZONA
Authorized official PETERSON GO - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 10/31/2022
Last updated 10/31/2022 - About 4 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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