Arizona Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ARIZONA CLINIC PLLC

Practice address

4834 E Broadway Blvd
Tucson, AZ 85711-3610

Phone

(206) 551-0154

Fax

(702) 441-1961

NPI assigned

Dec 4, 2023

Organization subpart

No

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

Authorized official

Name

Michael Minckler, MDNPI 1821437484

Title

Ceo

Phone

(206) 551-0154

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Corbin Ballam, DO

  • Internal Medicine Physician
  • Tucson, AZ
  • NPI 1205282894

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Michael Robert Minckler, M.D.

  • General Practice Physician
  • Tucson, AZ
  • NPI 1821437484

  Family Medicine

  Medicare reassignment NPD Authorized official
• Luis F Lozano, PA

  • Physician Assistant
  • Green Valley, AZ
  • NPI 1477172336
  Medicare reassignment Care Compare group
• Jessica L Haloskie, MD

  • Family Medicine Physician
  • Tucson, AZ
  • NPI 1356403778
  Medicare reassignment NPD
• Celia Leigh Lozano, DNP

  • Family Nurse Practitioner
  • Tucson, AZ
  • NPI 1083152631
  Medicare reassignment NPD
• Cristina Rose Etienne, P.A.

  • Physician Assistant
  • Phoenix, AZ
  • NPI 1023695525
  Medicare reassignment
• Gregory C Etienne, PA

  • Physician Assistant
  • Phoenix, AZ
  • NPI 1497384168
  Medicare reassignment
• Samuel Etienne, DR., PA

  • Medical Physician Assistant
  • Tempe, AZ
  • NPI 1134707300
  Medicare reassignment

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

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1053188771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4834 E BROADWAY BLVD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857113610",
            "telephone_number": "206-551-0154",
            "fax_number": "702-441-1961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4834 E BROADWAY BLVD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857113610",
            "telephone_number": "206-551-0154",
            "fax_number": "702-441-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "MINCKLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-551-0154",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Tucson, AZ
• Providers in Tucson, 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 Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.