Provider Demographics
NPI:1174102164
Name:MOUNTAIN AIR ADULT PRIMARY CARE, LLC
Entity type:Organization
Organization Name:MOUNTAIN AIR ADULT PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY-STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-301-1557
Mailing Address - Street 1:6026 E TALLY HO DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-8867
Mailing Address - Country:US
Mailing Address - Phone:602-301-1557
Mailing Address - Fax:
Practice Address - Street 1:6026 E TALLY HO DR
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-8867
Practice Address - Country:US
Practice Address - Phone:602-301-1557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP3245OtherLICENSE