COUNTRY DOCTOR INC NPI 1821550310

NPI Information

NPI: 1821550310
Provider Name: COUNTRY DOCTOR INC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 03D2169274

Address:
13260 N 94TH DR STE 102
PEORIA, AZ
ZIP 85381
Phone: (623) 815-0827
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COUNTRY DOCTOR INC is a primary care clinic center in Peoria, AZ. COUNTRY DOCTOR INC NPI is 1821550310. The provider is registered as an organization entity type.

The provider's business location address is:

13260 N 94TH DR STE 102
PEORIA, AZ
ZIP 85381-242
Phone: (623) 815-0827
Fax: (623) 875-0325

The provider's authorized official is Paul Lee Manganelli .
The authorized official title is President and has the following contact phone number (623) 815-0827.

The CLIA number assigned to this NPI record is 03D2169274 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/3/2019 and was last updated on 4/11/2019.

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	261QP2300X	Clinic/Center	Primary Care			Yes

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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