Az Mobile Medical Clinic LLC
Organization Active NPI General Practice Physician · Laveen, AZ
NPI 1013766484 · NPPES record last updated Apr 23, 2025
Key facts
- NPI
- 1013766484
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- AZ MOBILE MEDICAL CLINIC LLC
- Practice address
- 3933 W Thurman Dr
Laveen, AZ 85339-1232 - Phone
- (602) 962-8755
- Fax
- (602) 704-6002
- NPI assigned
- May 16, 2024
- Organization subpart
- No
Authorized official
- Name
- John Richard Groff Jr.
- Title
- Owner
- Phone
- (602) 723-2126
Practitioners 3
-
Laureen Cota, DPM
-
Yilia Myhre, FNP, PMHNP
-
Micah Ruben Ruybalid, NP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240702000563 | AZ | Part B Supplier - Clinic/Group Practice | 6002350014 |
Receives reassigned benefits from 3 practitioners Practice locations: Laveen, AZ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | Yes |
Addresses
Primary practice location
3933 W Thurman Dr
Laveen, AZ 85339-1232
Mailing address
3933 W Thurman Dr
Laveen, AZ 85339-1232
Phone (602) 962-8755
Other providers in Laveen, AZ
- Nakeya Joyce Ashe
- Assured Dignity Residential Care LLC
- At Peace Behavior Management
- Avenue to Hope LLC
- Az Champions LLC
- Az Quality Care LLC
- Azcare4Life
- Scott Babb
- Laura Baggiore
- Colette Baker
All providers in Laveen, AZ · General Practice Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.