# EXR4 MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508416918
- **Authorized official:** JEREMY BUCKNER DC (MEMBER)
- **Authorized official phone:** (602) 421-2730

## Contact information

- **Practice address:** 1984 E BASELINE RD, TEMPE, AZ 85283-1535
- **Practice address phone:** (480) 272-8944
- **Practice address fax:** (480) 930-4018
- **Mailing address:** 4540 E BASELINE RD STE 105, MESA, AZ 85206-4616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/17/2019
- **Last updated:** 07/15/2020