MMC Doc MD LLC

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

License

34403 Issued in AZ

Legal business name

MMC DOC MD LLC

Practice address

13216 N Plaza del Rio Blvd
Peoria, AZ 85381-4907

Phone

(623) 977-5003

NPI assigned

Sep 19, 2012

Organization subpart

No

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

Authorized official

Name

Srinivasa Reddy, MD

Title

Owner

Phone

(623) 341-6539

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1427309293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7298 W AVENIDA DEL SOL",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853833257",
            "telephone_number": "623-341-6539",
            "fax_number": "708-801-7128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13216 N PLAZA DEL RIO BLVD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814907",
            "telephone_number": "623-977-5003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMC DOC MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "SRINIVASA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-341-6539",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Hospitalist",
            "state": "AZ",
            "license": "34403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS ID - AZ MEDICAID",
            "identifier": "956740",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Nicole Mitchell, N.M.D.
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• Hospitalist Physician in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Hospitalist Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; 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.