Active NPI
Maryvale Integrated Medical Group - LLC
- Neurology Physician
- Phoneix, AZ
National Provider Identifier
1467656991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- Legal business name
- MARYVALE INTEGRATED MEDICAL GROUP - LLC
- Practice address
- 5251 W Campbell Ave
Ste 206
Phoneix, AZ 85031 - Phone
- (623) 848-3020
- Fax
- (623) 848-3019
- NPI assigned
- Jun 11, 2007
- Last updated
- Jul 21, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Thomas D Perry, MD
- Title
- MD President
- Phone
- (623) 848-3295
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | AZ | Primary |
Addresses
Primary practice location
5251 W Campbell Ave
Ste 206
Phoneix, AZ 85031
Mailing address
5251 W Campbell Ave
Ste 206
Phoneix, AZ 85031
Phone (623) 848-3020
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181520000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1467656991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5251 W CAMPBELL AVE",
"address_2": "STE 206",
"city": "PHONEIX",
"state": "AZ",
"postal_code": "85031",
"telephone_number": "623-848-3020",
"fax_number": "623-848-3019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5251 W CAMPBELL AVE",
"address_2": "STE 206",
"city": "PHONEIX",
"state": "AZ",
"postal_code": "85031",
"telephone_number": "623-848-3020",
"fax_number": "623-848-3019"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARYVALE INTEGRATED MEDICAL GROUP - LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-11",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "PERRY",
"authorized_official_first_name": "THOMAS",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "MD PRESIDENT",
"authorized_official_telephone_number": "623-848-3295",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "AZ",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoneix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.