Away Clinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

AWAY CLINIC LLC

Practice address

2201 W Fairview St Ste 1
Chandler, AZ 85224-4712

Phone

(480) 712-8865

NPI assigned

Jul 6, 2022

Organization subpart

No

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

Authorized official

Name

Paige Ellsworth

Title

Operations Coordinator

Phone

(480) 712-8865

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1104559376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 W FAIRVIEW ST STE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852244712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 W FAIRVIEW ST STE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852244712",
            "telephone_number": "480-712-8865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3308 N Higley Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852159781",
            "country_code": "US",
            "telephone_number": "480-712-8865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AWAY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-06",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "ELLSWORTH",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_title_or_position": "OPERATIONS COORDINATOR",
        "authorized_official_telephone_number": "480-712-8865"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chrisdeon Ayiyi
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• Clinic/Center in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.