Provider Demographics
NPI:1043830623
Name:FHMC CLINIC
Entity type:Organization
Organization Name:FHMC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEUME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-671-7990
Mailing Address - Street 1:9700 N SAGUARO BLVD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6241
Mailing Address - Country:US
Mailing Address - Phone:602-671-7990
Mailing Address - Fax:602-755-0456
Practice Address - Street 1:9700 N SAGUARO BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6241
Practice Address - Country:US
Practice Address - Phone:602-671-7990
Practice Address - Fax:602-755-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ089728Medicaid