# MCKELLIPS FAMILY MEDICAL CLINIC, PLLC

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

## Provider details

- **NPI number:** 1659787497
- **Authorized official:** CARL FERGUSON DO (PROVIDER)
- **Authorized official phone:** (480) 830-1553

## Contact information

- **Practice address:** 3514 N POWER RD, BLDG. 1, SUITE 105, MESA, AZ 85215-8521
- **Practice address phone:** (480) 422-8533
- **Mailing address:** 3514 N POWER RD STE 105, MESA, AZ 85215-2907
- **Mailing address phone:** (480) 422-8533
- **Mailing address fax:** (480) 981-2442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/01/2014
- **Last updated:** 11/01/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 273665 | — | AZ |
| 01 | — | 7200350001 | PTAN | AZ |