Provider Demographics
NPI:1174883623
Name:SAN TAN URGENT HEALTH CARE CENTER
Entity type:Organization
Organization Name:SAN TAN URGENT HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:MORRISON
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-458-5135
Mailing Address - Street 1:21321 E OCOTILLO RD STE 118
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5994
Mailing Address - Country:US
Mailing Address - Phone:480-458-5135
Mailing Address - Fax:480-458-5241
Practice Address - Street 1:2081 W US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-5445
Practice Address - Country:US
Practice Address - Phone:480-458-5135
Practice Address - Fax:480-458-5241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN TAN URGENT HEALTH CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34307261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI46617Medicare UPIN