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VERSATILE MEDICINE PLLC NPI 1326145608


NPI Information

NPI: 1326145608
Provider Name: VERSATILE MEDICINE PLLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 03D0925554

Address:
13055 W MCDOWELL RD
SUITE E-106
AVONDALE, AZ
ZIP 85392
Phone: (623) 975-8400
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VERSATILE MEDICINE PLLC is an internal medicine in Avondale, AZ. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. VERSATILE MEDICINE PLLC NPI is 1326145608. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

13055 W MCDOWELL RD
SUITE E-106
AVONDALE, AZ
ZIP 85392-449
Phone: (623) 975-8400
Fax: (623) 935-2975

The provider's authorized official is Kathleen A Nichols .
The authorized official title is Physician/general Manager and has the following contact phone number (623) 975-8400.

The CLIA number assigned to this NPI record is 03D0925554 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/20/2006 and was last updated on 6/8/2015.


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
1207R00000XInternal MedicineAZ26993ARIZONAYes

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
1AZ0765500OTHERARIZONABLUE CROSS BLUE SHIELD
2Z85584MEDICARE ID-TYPE UNSPECIFIEDARIZONA
3H24006MEDICARE UPINARIZONA
4486581001MEDICAIDARIZONA
5AZ0761300OTHERARIZONABLUE CROSS BLUE SHIELD
6H06555MEDICARE UPINARIZONA
7Z104450MEDICARE ID-TYPE UNSPECIFIEDARIZONA
8517675MEDICAIDARIZONA

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.