NPIMap

Organization Active NPI

Clean Colonic LLC

  • Durable Medical Equipment & Medical Supplies
  • Tempe, AZ
National Provider Identifier
1609226364
Registry record updated Jan 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
CLEAN COLONIC LLC
Practice address
7560 S. Willow Dr
Tempe, AZ 85283
Phone
(952) 994-3554
NPI assigned
Jun 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2017

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

Authorized official

Name
Carolyn Dee BerryNPI 1275075608
Title
Colon Hydrotherapist
Phone
(480) 269-5575

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

7560 S. Willow Dr
Tempe, AZ 85283

Mailing address

7560 S Willow Dr
Tempe, AZ 85283-5004
Phone (480) 269-5575

National Provider Directory

National Provider Directory

Locations

7560 S Willow Dr
Tempe, AZ 85283
Phone (480) 269-5575

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484784000000",
    "number": "1609226364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7560 S WILLOW DR",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852835004",
            "telephone_number": "480-269-5575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7560 S. WILLOW DR",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "85283",
            "telephone_number": "952-994-3554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAN COLONIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2017-01-19",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "COLON HYDROTHERAPIST",
        "authorized_official_telephone_number": "480-269-5575"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

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