Organization
STATCLINIX PLC
Active
Other names
StatClinix - Lakeside
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLEE MILLER (MEDICAL STAFF COORDINATOR)
(480) 682-4118
Entity
Organization
Contact information
Practice address
3457 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929
(928) 358-1515
(928) 358-1517
Mailing address
1151 N GILBERT RD, MESA, AZ 85203-5127
(450) 682-4118
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AZ
Enumeration date
04/19/2018
Last updated
04/19/2018
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