Organization · NPI-2

Grand West Family Practice And Wellness LLC

Family Medicine · Sun City, AZ

NPI number1740055599
StatusActive
Last updated in NPPESFeb 6, 2024

Details

NPI
1740055599
Entity type
Organization (NPI-2)
Legal business name
Grand West Family Practice And Wellness LLC
Organization subpart
No
Enumeration date
Nov 21, 2023
Certification date
Feb 6, 2024
Last updated
Feb 6, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Other names

  • Grand West Family Practice And Wellness LLC (Doing Business As)

Practice location

13000 N 103rd Ave Ste 77
Sun City, AZ 85351-3057

Phone 480-284-5650 · Fax 480-284-6431

Mailing address

13000 N 103rd Ave Ste 77
Sun City, AZ 85351-3057

Phone 480-284-5650 · Fax 480-284-6431

Authorized official

Shelly Tellman
Owner/Manager
6238245017

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