# COUNTRY CLUB MEDICAL GROUP P C

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTHEAST VALLEY MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649256777
- **Authorized official:** MRS. SILVIA O'LEARY (OFFICE MANAGER)
- **Authorized official phone:** (480) 969-1446

## Contact information

- **Practice address:** 1950 S COUNTRY CLUB DR, MESA, AZ 85210-6008
- **Practice address phone:** (480) 969-1446
- **Practice address fax:** (480) 969-9105
- **Mailing address:** 1950 S COUNTRY CLUB DR, MESA, AZ 85210-6008
- **Mailing address phone:** (480) 969-1446
- **Mailing address fax:** (480) 969-9105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2005
- **Last updated:** 06/22/2010