Providence General Medicine

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

AP3603 Issued in AZ

Legal business name

PROVIDENCE GENERAL MEDICINE

Practice address

1701 W Glendale Ave
Phoenix, AZ 85021-9701

Phone

(602) 246-9090

Fax

(602) 246-9867

NPI assigned

Mar 25, 2010

Last updated

Mar 25, 2010By 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

Ms. Blanca Marquez

Title

Manager

Phone

(602) 254-7077

Specialties & licenses 1

Addresses

Tax ID family

Providence General Medicine2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Pediatrics

  • Pediatrics Physician
  • Phoenix, AZ
  • NPI 1962673772
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rosalia Jimenez Vasquez, N.P. (NURSE PRACTITI

  • Family Nurse Practitioner
  • Tempe, AZ
  • NPI 1023267200
  NPD (past)

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

{
    "created_epoch": "1269475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269475200000",
    "number": "1508180043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W GLENDALE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850219701",
            "telephone_number": "602-246-9090",
            "fax_number": "602-246-9867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W GLENDALE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850219701",
            "telephone_number": "602-246-9090",
            "fax_number": "602-246-9867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE GENERAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-25",
        "last_updated": "2010-03-25",
        "status": "A",
        "authorized_official_last_name": "MARQUEZ",
        "authorized_official_first_name": "BLANCA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "602-254-7077",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "AZ",
            "license": "AP3603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prostate Solutions of Arizona, P.C.
• Protherapy Staffing
• Brandi Protonentis
• Jeffrey C Proudfoot, D.O.
• Proudly Arizona LLC
• Providence General Medicine, PC
• Providence Health Group LLC (Genesis Wellness & Pain Management Center)
• Providence Hospice and Palliative Care Inc
• Providence of Arizona, Inc.
• Providence Pediatrics

• Medical Specialty Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Medical Specialty Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2010; 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.