Provider Demographics
NPI:1023852928
Name:FIRST PERSON CARE CLINIC
Entity type:Organization
Organization Name:FIRST PERSON CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARANIUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-447-6841
Mailing Address - Street 1:1200 S 4TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1046
Mailing Address - Country:US
Mailing Address - Phone:702-380-8118
Mailing Address - Fax:
Practice Address - Street 1:2226 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1411
Practice Address - Country:US
Practice Address - Phone:702-380-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST PERSON CARE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-24
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty