Organization
FENIX MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUSTIN FAIR PT (OWNER)
(480) 788-0399
Entity
Organization
Contact information
Practice address
18477 S 186TH WAY STE 102, QUEEN CREEK, AZ 85142-9620
(480) 788-0399
Mailing address
18477 S 186TH WAY STE 102, QUEEN CREEK, AZ 85142-9620
(480) 788-0399
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1
N/A
—
Enumeration date
05/11/2022
Last updated
05/11/2022
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