MOUNTAIN PARK HEALTH CENTER (NPI# 1376640656) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376640656 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN PARK HEALTH CENTER |
| Practice Address |
1840 E Broadway Rd Tempe AZ 85282-1614 |
| Mailing Address |
3003 N Central Ave Ste 1600 Phoenix AZ 85012-2908 |
| Practice Telephone | 6022437277 |
| Practice Fax Number | 4809271092 |
| Mailing Telephone | 6023233242 |
| Mailing Fax Number | 6023233496 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2018-03-12 |
| Authorized Official Name | JOHN R SWAGERT (CEO) |
| Authorized Official Telephone | 6023233242 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | MOUNTAIN PARK HEALTH CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
OTC 4015 | AZ | Ambulatory Health Care Facilities |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386741668 | Mountain Park Health Center | Clinic/Center | 3830 E Van Buren St, Phoenix, AZ 85008-6936 | 2006-09-20 |
| 1922105204 | Mountain Park Health Center | Clinic/Center | 140 N Litchfield Rd Ste 200&106, Goodyear, AZ 85338-1277 | 2006-09-20 |
| 1811490881 | Mountain Park Health Center | Clinic/Center | 303 E Baseline Rd, Phoenix, AZ 85042-6530 | 2018-03-15 |
| 1487037958 | Mountain Park Health Center | Clinic/Center | 5517 N 17th Ave, Phoenix, AZ 85015-2516 | 2015-07-02 |
| 1386027852 | Mountain Park Health Center | Clinic/Center | 17624 N 31st Ave, Phoenix, AZ 85053-1935 | 2015-07-02 |
| 1740663210 | Mountain Park Health Center | Clinic/Center | 4315 N Maryvale Pkwy, Phoenix, AZ 85031-1942 | 2015-07-02 |
| 1669878567 | Mountain Park Health Center | Clinic/Center | 3003 N Central Ave Ste 1600, Phoenix, AZ 85012-2908 | 2014-11-05 |
| 1467630012 | Mountain Park Health Center | Pharmacy | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2008-02-06 |
| 1578741120 | Mountain Park Health Center | Pharmacy | 6601 W Thomas Rd, Phoenix, AZ 85033-5700 | 2008-02-06 |
| 1740387018 | Mountain Park Health Center | Clinic/Center | 6601 West Thomas Road, Phoenix, AZ 85035-5700 | 2006-09-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MOUNTAIN PARK HEALTH CENTER | 3003 N Central Ave Ste 1600, Phoenix, AZ 85012-2908 |
| Street Address |
1840 E BROADWAY RD |
| City | TEMPE |
| State | AZ |
| Zip Code | 85282-1614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558359109 | Roxie Anderson | Nurse Practitioner | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2005-10-07 |
| 1043819733 | Blessy Joseph | Nurse Practitioner | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2020-10-22 |
| 1124500681 | Tana D Ingram | Dietitian, Registered | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2018-08-31 |
| 1164902011 | Jessica Lynn Leslie | Dietitian, Registered | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2018-08-20 |
| 1598214066 | Jody Ortman | Psychologist | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2016-09-26 |
| 1962816876 | Stephanie Ayita Jugmohan | Family Medicine | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2014-06-18 |
| 1891107322 | Dawn Christia Bridges-jones | Registered Nurse | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2014-06-02 |
| 1134413180 | Jake B Barnard | Pediatrics | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2011-06-07 |
| 1437395316 | Sabrina Eymer Marmont | Nurse Practitioner | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2008-12-26 |
| 1588613707 | John C Avery | Family Medicine | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2006-05-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346893575 | Cactus Canyon Dental | Dentist | 2043 E Southern Ave, Ste. C, Tempe, AZ 85282 | 2019-07-17 |
| 1023679644 | Donna Cooks | Registered Nurse | 233 E. Sourthern Ave #27702, Tempe, AZ 85282 | 2019-06-25 |
| 1841854932 | Lynn Stafford | Registered Nurse | 4041 S. Mcclintock, Ste 302, Tempe, AZ 85282 | 2019-04-24 |
| 1598227340 | Jane Ramenofsky Ramenofsky Stewart | Registered Nurse | 4041 So. Mcclintock Suite 302, Tempe, AZ 85282 | 2019-04-02 |
| 1588129902 | Mary K Wheeler Mcfarland | Registered Nurse | Adobe Care and Wellness LLC, Address Is 4041 S. Mcclintock, Ste 302, Tempe, AZ 85282 | 2019-02-11 |
| 1669949780 | Crestview Pharmacy Services LLC | Pharmacy | 3225 South Hardy Dr., Ste 100, Tempe, AZ 85282 | 2018-10-26 |
| 1275018715 | Berlin Wright | Naturopath | 2164 E. Broadway Rd., Tempe, AZ 85282 | 2018-10-01 |
| 1043701543 | Lakeshore Interventional Treatment Center LLC | Surgery | 4765 S Lakeshore Dr, Tempe, AZ 85282 | 2018-05-21 |
| 1427553940 | The Bridge Counseling, Consulting and Mediation LLC | Counselor | 4625 S. Lakeshore Dr., 302, Tempe, AZ 85282 | 2018-03-27 |
| 1346741501 | Coraesthetics Pllc | Physician Assistant | 2008 E Laguna Dr, Tempe, AZ 85282 | 2018-02-23 |
| Find all providers in zip 85282 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.