NPIMap

Organization Active NPI

Landmark Medical LLC

  • Physical Medicine & Rehabilitation Physician
  • Mesa, AZ
National Provider Identifier
1760089049
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
LANDMARK MEDICAL LLC
Practice address
3614 E Southern Ave Ste 105
Mesa, AZ 85206-2510
Phone
(480) 838-6696
NPI assigned
Oct 8, 2020
Last updated
Oct 8, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
LANDMARK MEDICAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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

Authorized official

Name
Justin D Thompson
Title
Manager
Phone
(435) 760-5896

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Nurse Practitioner 363L00000X NU
Chiropractor 111N00000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU Primary
Pain Medicine Physician 208VP0000X NU

Addresses

Primary practice location

3614 E Southern Ave Ste 105
Mesa, AZ 85206-2510

Mailing address

2340 W Parkside LN Ste H107
Phoenix, AZ 85027-1274
Phone (602) 354-5310

National Provider Directory

National Provider Directory
Tax ID family
Landmark Medical LLC5 organizations share this tax ID, including this one
Part of
Landmark Medical LLC

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602115200000",
    "number": "1760089049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2340 W PARKSIDE LN STE H107",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850271274",
            "telephone_number": "602-354-5310",
            "fax_number": "480-887-8041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3614 E SOUTHERN AVE STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852062510",
            "telephone_number": "480-838-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANDMARK MEDICAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LANDMARK MEDICAL LLC",
        "enumeration_date": "2020-10-08",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "435-760-5896"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; 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.