Provider Demographics
NPI:1447673868
Name:ARIZONA PROACTIVE HEALTH AND MEDICINE
Entity type:Organization
Organization Name:ARIZONA PROACTIVE HEALTH AND MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SEVOY
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLERUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-366-4496
Mailing Address - Street 1:81 W GUADALUPE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3321
Mailing Address - Country:US
Mailing Address - Phone:480-366-4496
Mailing Address - Fax:800-448-0729
Practice Address - Street 1:81 W GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3321
Practice Address - Country:US
Practice Address - Phone:480-366-4496
Practice Address - Fax:800-448-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZP18967986208D00000X
AZ36126261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty