Provider Demographics
NPI:1871584698
Name:NEIGHBORHOOD FAMILY PRACTICE PC
Entity type:Organization
Organization Name:NEIGHBORHOOD FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-949-7340
Mailing Address - Street 1:6360 E THOMAS RD
Mailing Address - Street 2:STE 218
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7054
Mailing Address - Country:US
Mailing Address - Phone:480-949-7340
Mailing Address - Fax:480-949-7344
Practice Address - Street 1:6360 E THOMAS RD
Practice Address - Street 2:STE 218
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7054
Practice Address - Country:US
Practice Address - Phone:480-949-7340
Practice Address - Fax:480-949-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72556Medicare ID - Type Unspecified