Access2Care Family Medical Center, Inc.
Organization Active NPI Family Medicine Physician · Phoenix, AZ
NPI 1467653147 · NPPES record last updated Mar 3, 2008
Key facts
- NPI
- 1467653147
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 23710 (AZ)
- Legal business name
- ACCESS2CARE FAMILY MEDICAL CENTER, INC.
- Practice address
- 4607 N 12TH St
Phoenix, AZ 85014-4006 - Phone
- (602) 690-0510
- NPI assigned
- May 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Olu Onisile, MD
- Title
- President
- Phone
- (602) 690-0510
Practitioners 6
-
Oludare Onisile, MD
-
Robert G Mitchelson, P A
-
Cheryl L Stanton, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040326001265 | AZ | Part B Supplier - Clinic/Group Practice | 3375435068 |
Receives reassigned benefits from 1 practitioner Practice locations: Payson, AZ; Phoenix, AZ |
National Provider Directory
Locations
4607 N 12th St
Phoenix, AZ 85014
Phone (480) 690-5210
2741 W Southern Ave
Ste 17
Tempe, AZ 85282
Phone (602) 454-8818
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 23710 | AZ | Yes |
Addresses
Primary practice location
4607 N 12TH St
Phoenix, AZ 85014-4006
Mailing address
4607 N 12TH St
Phoenix, AZ 85014-4006
Phone (602) 690-0510
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All providers in Phoenix, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.