COUNTRY CLINIC PC NPI 1740561562

NPI Information

NPI: 1740561562
Provider Name: COUNTRY CLINIC PC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
26416 S MANDARIN DR
QUEEN CREEK, AZ
ZIP 85142
Phone: (480) 369-0582
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COUNTRY CLINIC PC is a family nurse practitioner in Queen Creek, AZ. COUNTRY CLINIC PC NPI is 1740561562. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

26416 S MANDARIN DR
QUEEN CREEK, AZ
ZIP 85142-411
Phone: (480) 369-0582
Fax: (480) 279-4274

The provider's authorized official is Katherine C Hakeman .
The authorized official title is President and has the following contact phone number (480) 369-0582.

The enumeration date for this NPI number is 9/7/2011 and was last updated on 3/14/2012.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	AP2088	ARIZONA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	Z148164	MEDICARE PIN	ARIZONA
2	644363	MEDICAID	ARIZONA

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

NPI Synchronization or Removal

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