Provider Demographics
NPI:1588557383
Name:EAST VALLEY DIRECT PRIMARY CARE LLC
Entity type:Organization
Organization Name:EAST VALLEY DIRECT PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FROESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-878-6450
Mailing Address - Street 1:8607 E PECOS RD STE 116
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-6572
Mailing Address - Country:US
Mailing Address - Phone:602-878-6450
Mailing Address - Fax:
Practice Address - Street 1:8607 E PECOS RD STE 116
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-6572
Practice Address - Country:US
Practice Address - Phone:602-878-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care