Made Whole Medical Center LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MADE WHOLE MEDICAL CENTER LLC

Doing business as

Made Whole Medical Center LLC

Practice address

13048 W Rancho Santa Fe Blvd
Avondale, AZ 85392-1705

Phone

(623) 300-6457

Fax

(855) 300-5330

NPI assigned

Oct 9, 2023

Last updated

Oct 21, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

CLINICALAs reported in NPPES

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

Authorized official

Name

Caremla J Banks

Title

Owner

Phone

(623) 300-6457

Specialties & licenses 9

Addresses

Other names 1

• MADE WHOLE MEDICAL CENTER LLC Doing business as

Part of

Made Whole Medical Center LLC

Locations

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697846400000",
    "number": "1245011006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13048 W RANCHO SANTA FE BLVD",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853921705",
            "telephone_number": "623-300-6457",
            "fax_number": "855-300-5330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13048 W RANCHO SANTA FE BLVD",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853921705",
            "telephone_number": "623-300-6457",
            "fax_number": "855-300-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADE WHOLE MEDICAL CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLINICAL",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-21",
        "certification_date": "2023-10-21",
        "status": "A",
        "authorized_official_last_name": "BANKS",
        "authorized_official_first_name": "CAREMLA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-300-6457"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Prison Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADE WHOLE MEDICAL CENTER LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samantha Levonne Lyons
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• Maxwell S Maccollum III, M.D.
• Jacob Maddox
• Yvonne Maese, NP
• Fedelia Maez, PA-C
• Jasmin Magana, RN
• Adnan Mahmood, DO
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• Clinic/Center in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2023; 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.