Professional PA-C Services, LLC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

4317 Issued in AZ

Legal business name

PROFESSIONAL PA-C SERVICES, LLC

Practice address

1800 E Florence Blvd
Casa Grande, AZ 85122-5303

Phone

(801) 369-4800

Fax

(480) 248-9011

NPI assigned

Feb 2, 2012

Last updated

Apr 10, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kristi Marie Preston, PA-C

Title

Manager

Phone

(801) 369-4800

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1396017661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24298 S 199TH ST",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851423336",
            "telephone_number": "801-369-4800",
            "fax_number": "480-248-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E FLORENCE BLVD",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851225303",
            "telephone_number": "801-369-4800",
            "fax_number": "480-248-9011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PA-C SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-02",
        "last_updated": "2017-04-10",
        "status": "A",
        "authorized_official_last_name": "PRESTON",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "801-369-4800",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "4317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Eyecare Associates, Inc.
• Progressive Pain Management
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• Promenade Smiles, LLP (Promenade Smiles)
• Victor Provencio, RPH
• Provision Foundation

• Medical Physician Assistant in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; 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.