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Organization
COUNTRY CLUB MEDICAL GROUP P C
Active
Organization
COUNTRY CLUB MEDICAL GROUP P C
Active
Other names
SOUTHEAST VALLEY MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SILVIA O'LEARY (OFFICE MANAGER)
(480) 969-1446
Entity
Organization
Contact information
Practice address
1950 S COUNTRY CLUB DR, MESA, AZ 85210-6008
(480) 969-1446
(480) 969-9105
Mailing address
1950 S COUNTRY CLUB DR, MESA, AZ 85210-6008
(480) 969-1446
(480) 969-9105
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/20/2005
Last updated
06/22/2010
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