Mayne Medical, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

MAYNE MEDICAL, LLC

Practice address

4524 N Maryvale Pkwy Ste 160
Phoenix, AZ 85031-1739

Phone

(480) 688-3321

Fax

(480) 393-7197

NPI assigned

Aug 12, 2022

Organization subpart

No

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

Authorized official

Name

Jennelle Suarez, PA-C

Title

Owner, PA, Rendering Provider

Phone

(480) 688-3321

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennelle Lynne Daly, PA-C

  • Medical Physician Assistant
  • Scottsdale, AZ
  • NPI 1295233997
  NPD

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

{
    "created_epoch": "1660262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1366170656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10645 N TATUM BLVD STE C200464",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850280425",
            "telephone_number": "480-688-3321",
            "fax_number": "480-393-7197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4524 N MARYVALE PKWY STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850311739",
            "telephone_number": "480-688-3321",
            "fax_number": "480-393-7197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYNE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-12",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "SUAREZ",
        "authorized_official_first_name": "JENNELLE",
        "authorized_official_title_or_position": "OWNER, PA, RENDERING PROVIDER",
        "authorized_official_telephone_number": "480-688-3321",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shamaine Tatyana Maylor
• Mary J Maymana, M.D.
• Andrew Maynard, MD
• Justin John Maynard, DO
• Lauren Michelle Maynard
• Brett M. Mayne, PA
• Shari Mayne
• Domingo L Maynes III, M.D.
• Mayo Clinic Arizona
• Mayo Clinic Arizona

• Physical Medicine & Rehabilitation Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Medicine & Rehabilitation Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.