# CAVE CREEK CLINIC, LLC

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

## Provider details

- **NPI number:** 1578028684
- **Authorized official:** DR. JOHN SHERMAN GILLIAM MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (480) 401-1555

## Contact information

- **Practice address:** 2920 E MOHAWK LN STE 101, PHOENIX, AZ 85050-4773
- **Practice address phone:** (480) 401-1555
- **Practice address fax:** (800) 930-4408
- **Mailing address:** 15029 N THOMPSON PEAK PKWY \# B111-438, SCOTTSDALE, AZ 85260-2217
- **Mailing address phone:** (480) 401-1555
- **Mailing address fax:** (800) 930-4408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/02/2019
- **Last updated:** 06/11/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 388615 | — | AZ |
| 05 | — | 600874 | — | AZ |