Organization
MCKELLIPS FAMILY MEDICAL CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL FERGUSON DO (PROVIDER)
(480) 830-1553
Entity
Organization
Contact information
Practice address
3514 N POWER RD, BLDG. 1, SUITE 105, MESA, AZ 85215-8521
(480) 422-8533
Mailing address
3514 N POWER RD STE 105, MESA, AZ 85215-2907
(480) 422-8533
(480) 981-2442
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273665
—
AZ
01
—
7200350001
PTAN
AZ
Enumeration date
07/01/2014
Last updated
11/01/2019
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