Clean Colonic Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CLEAN COLONIC FAMILY PRACTICE

Practice address

4744 E Thunderbird Rd Ste 4
Phoenix, AZ 85032-5577

Phone

(480) 269-5575

NPI assigned

Mar 19, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carolyn Berry

Title

Owner

Phone

(480) 269-5575

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1003492158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4744 E THUNDERBIRD RD STE 4",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850325577",
            "telephone_number": "480-269-5575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4744 E THUNDERBIRD RD STE 4",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850325577",
            "telephone_number": "480-269-5575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2034 E Southern Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852827511",
            "country_code": "US",
            "telephone_number": "480-269-5575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16718 E Avenue Of The Fountains Ste 100",
            "address_purpose": "LOCATION",
            "city": "Fountain Hills",
            "state": "AZ",
            "postal_code": "852684165",
            "country_code": "US",
            "telephone_number": "480-269-5575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLEAN COLONIC FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-19",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-269-5575"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@cleancolonic.com",
            "affiliation": "N",
            "address_1": "4744 E Thunderbird Rd Ste 4",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850325577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Melinda Rose Claypool, CNP
• Linda Elaine Clayton-Dhennin, RN, AGCNS-BC
• Alec Martin Clayton, DO
• Taylor Nicole Clayton
• Tyler W Clayton, D.M.D
• Cleancatchpro LLC
• Cleanslate Medical Group of Arizona PLLC
• Cleanslate Medical Group of Arizona PLLC
• Cleanslate Medical Group of Arizona PLLC
• Cleanslate Medical Group of Arizona PLLC

• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.