Active NPI
Marshawn Mitchell Sr.
- Clinic/Center
- Buckeye, AZ
National Provider Identifier
1104243500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Practice address
- 23605 W Bowker St
Buckeye, AZ 85326-7217 - Phone
- (757) 763-0754
- NPI assigned
- Mar 24, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
23605 W Bowker St
Buckeye, AZ 85326-7217
Mailing address
23605 W Bowker St
Buckeye, AZ 85326-7217
Phone (757) 763-0754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395619200000",
"number": "1104243500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23605 W BOWKER ST",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853267217",
"telephone_number": "757-763-0754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23605 W BOWKER ST",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853267217",
"telephone_number": "757-763-0754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "MARSHAWN",
"name_suffix": "Sr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-03-24",
"last_updated": "2014-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.