MOUNTAIN PARK HEALTH CENTER (NPI# 1467630012) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467630012 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN PARK HEALTH CENTER |
| Practice Address |
635 E Baseline Rd Phoenix AZ 85042-6551 |
| Mailing Address |
3003 N Central Ave Ste 1600 Phoenix AZ 85012-2908 |
| Practice Telephone | 6023233435 |
| Practice Fax Number | 6023058590 |
| Mailing Telephone | 6023233242 |
| Mailing Fax Number | 6023233496 |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2019-11-21 |
| Authorized Official Name | MARY SOTO (ASSOCIATE PHARMACY DIRECTOR) |
| Authorized Official Telephone | 6025863026 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | Y |
| Parent Organization Name | MOUNTAIN PARK HEALTH CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
3254 | AZ | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | BOARD OF PHARMACY | 3254 | 01 |
| AZ | 530073 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386741668 | Mountain Park Health Center | Clinic/Center | 3830 E Van Buren St, Phoenix, AZ 85008-6936 | 2006-09-20 |
| 1922105204 | Mountain Park Health Center | Clinic/Center | 140 N Litchfield Rd Ste 200&106, Goodyear, AZ 85338-1277 | 2006-09-20 |
| 1811490881 | Mountain Park Health Center | Clinic/Center | 303 E Baseline Rd, Phoenix, AZ 85042-6530 | 2018-03-15 |
| 1487037958 | Mountain Park Health Center | Clinic/Center | 5517 N 17th Ave, Phoenix, AZ 85015-2516 | 2015-07-02 |
| 1386027852 | Mountain Park Health Center | Clinic/Center | 17624 N 31st Ave, Phoenix, AZ 85053-1935 | 2015-07-02 |
| 1740663210 | Mountain Park Health Center | Clinic/Center | 4315 N Maryvale Pkwy, Phoenix, AZ 85031-1942 | 2015-07-02 |
| 1669878567 | Mountain Park Health Center | Clinic/Center | 3003 N Central Ave Ste 1600, Phoenix, AZ 85012-2908 | 2014-11-05 |
| 1578741120 | Mountain Park Health Center | Pharmacy | 6601 W Thomas Rd, Phoenix, AZ 85033-5700 | 2008-02-06 |
| 1740387018 | Mountain Park Health Center | Clinic/Center | 6601 West Thomas Road, Phoenix, AZ 85035-5700 | 2006-09-20 |
| 1376640656 | Mountain Park Health Center | Clinic/Center | 1840 E Broadway Rd, Tempe, AZ 85282-1614 | 2006-09-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MOUNTAIN PARK HEALTH CENTER | 3003 N Central Ave Ste 1600, Phoenix, AZ 85012-2908 |
| Street Address |
635 E BASELINE RD |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85042-6551 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164414892 | Neil Trachtenberg | Obstetrics & Gynecology | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2005-08-18 |
| 1548884240 | Heather E Weninger | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2020-05-29 |
| 1245863786 | Katherine Marie Bear | Nurse Practitioner | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2020-02-12 |
| 1841821642 | Manyil Dashe | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6583 | 2020-01-30 |
| 1962045112 | Natasha Burrell | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6583 | 2019-10-21 |
| 1215404652 | Heather Diane Hargrave | Physician Assistant | 635 E Baseline Rd, Phoenix, AZ 85042 | 2018-10-24 |
| 1700351475 | Robert Eugene Carter | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6583 | 2018-10-09 |
| 1134605132 | Philsy Jaison | Nurse Practitioner | 635 E Baseline Rd, Phoenix, AZ 85042-6583 | 2018-07-13 |
| 1891208948 | Samantha Thompson | Pharmacist | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2017-11-12 |
| 1295259075 | Evelyn Coronado | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2017-08-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306443197 | Da Homes LLC | Case Management | 8026 S. 24th Way, Phoenix, AZ 85042 | 2020-10-05 |
| 1144790460 | Ebony House Inc | Substance Abuse Rehabilitation Facility | 6222 S. 13th Street, Phoenix, AZ 85042 | 2018-11-29 |
| 1427538362 | Abigail Mcgrath | Dietitian, Registered | 303 E Baseline Rd Ste 200, Phoenix, AZ 85042 | 2018-08-20 |
| 1174028310 | Olufemi A Omodara | Pharmacist | 7227 S. Central Ave, #1080, Phoenix, AZ 85042 | 2018-03-29 |
| 1720537699 | Mary Youngblood | Registered Nurse | 7210 S 27th Way, Phoenix, AZ 85042 | 2016-10-03 |
| 1922490382 | Brian Zembower | Optometrist | 610 E Baseline Rd Ste C3, Phoenix, AZ 85042 | 2015-02-23 |
| 1417299819 | Robert Murphy Portley | Psychiatry & Neurology | 2320 E Baseline Rd Ste 148-225, Phoenix, AZ 85042 | 2013-03-23 |
| 1972807998 | Obinna Chukwuka Akubukwe | Pharmacist | 6006 S. Central Avenue, Phoenix, AZ 85042 | 2011-01-05 |
| 1104120328 | Gisheys Patient Care LLC | Custodial Care Facility | 7232 South 12th Place, Phoeniz, AZ 85042 | 2011-01-03 |
| 1245463488 | Lois Ann Hammitt | Registered Nurse | 6218 S. 7th Street, Phoenix, AZ 85042 | 2009-09-03 |
| Find all providers in zip 85042 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215567011 | Kleins of Jacksonville Inc | Pharmacy | 14330 Jarrettsville Pike, Phoenix, MD 21131-1743 | 2020-01-21 |
| 1578741120 | Mountain Park Health Center | Pharmacy | 6601 W Thomas Rd, Phoenix, AZ 85033-5700 | 2008-02-06 |
| 1497848824 | Banner Health | Pharmacy | 925 E Mcdowell Rd, Phoenix, AZ 85006-2502 | 2006-09-30 |
| 1598867996 | Banner Health | Pharmacy | 1111 E Mcdowell Rd, Phoenix, AZ 85006-2612 | 2006-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154989168 | Community Hospital Association, Inc. | Pharmacy | 26750b S. Santa Fe Rd., Congress, AZ 85332 | 2019-06-04 |
| 1154688927 | Marana Health Center Inc | Pharmacy | 899 N Wilmot Rd Ste B, Tucson, AZ 85711-1712 | 2012-04-18 |
| 1245357706 | West Kingman Pharmacy, LLC | Pharmacy | 3135 N Stockton Hill Rd, Kingman, AZ 86401 | 2007-03-22 |
| 1649334442 | North Country Healthcare, Inc. | Pharmacy | 2920 North 4th Street, Flagstaff, AZ 86004 | 2006-12-19 |
| 1730295684 | State of Arizona | Pharmacy | 1295 N Martin, Tucson, AZ 85721-0001 | 2006-08-22 |
| 1023122843 | Cardiojost, Inc | Pharmacy | 140 S Power Rd Ste 102, Mesa, AZ 85206-5297 | 2006-08-18 |
| 1376502054 | Sunset Community Health Center Inc | Pharmacy | 815 E Cesar Chavez Blvd, San Luis, AZ 85349 | 2006-03-21 |
| 1275519241 | El Rio Health Center (southwest) | Pharmacy | 1510 W Commerce Court, Tucson, AZ 85746-6015 | 2005-12-21 |
| 1447242417 | Cigna Health Care of Arizona Inc | Pharmacy | 1920 E Baseline Rd, Tempe, AZ 85283-1511 | 2005-08-16 |
| 1992797930 | Cigna Health Care of Arizona Inc | Pharmacy | 9069 W Thunderbird, Peoria, AZ 85381 | 2005-08-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.