Provider Demographics
NPI:1871546036
Name:ESTRELLA PKWY MEDICAL CENTER, LLC.
Entity type:Organization
Organization Name:ESTRELLA PKWY MEDICAL CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRION
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MUSCARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-932-9211
Mailing Address - Street 1:530 N ESTRELLA PKWY
Mailing Address - Street 2:STE. C-1
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4137
Mailing Address - Country:US
Mailing Address - Phone:623-932-9211
Mailing Address - Fax:623-932-9210
Practice Address - Street 1:530 N ESTRELLA PKWY
Practice Address - Street 2:STE. C-1
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4137
Practice Address - Country:US
Practice Address - Phone:623-932-9211
Practice Address - Fax:623-932-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7681111N00000X
AZ3789363AM0700X
AZAP3364363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7472280001Medicare NSC