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HERITAGE TECHNOLOGIES LLC NPI 1093764938


NPI Information

NPI: 1093764938
Provider Name: HERITAGE TECHNOLOGIES, LLC

Doing Business As: DESERT GROVE FAMILY MEDICAL

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 03D1103845

Address:
840 E MCKELLIPS RD
STE 101
MESA, AZ
ZIP 85203
Phone: (480) 834-7546
Get Directions

HERITAGE TECHNOLOGIES, LLC is a family medicine in Mesa, AZ. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. HERITAGE TECHNOLOGIES, LLC NPI is 1093764938. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Desert Grove Family Medical.

The provider's business location address is:

840 E MCKELLIPS RD
STE 101
MESA, AZ
ZIP 85203-645
Phone: (480) 834-7546
Fax: (480) 834-8001

The provider's authorized official is Michelle Dinsdale .
The authorized official title is Director Of Operations and has the following contact phone number (480) 834-7546.

The CLIA number assigned to this NPI record is 03D1103845 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/9/2006 and was last updated on 7/17/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1633795MEDICAIDARIZONA
2Z25781MEDICARE PINARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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