SOUTHEAST VALLEY MEDICAL GROUP
NPI 1649256777
Family Medicine in Mesa, AZ

Q: What is Country Club Medical Group P C's NPI number?

The NPI number for Country Club Medical Group P C is 1649256777. It was assigned to this organization in the NPPES registry on December 20, 2005. The provider is doing business as Southeast Valley Medical Group.

Q: What is Country Club Medical Group P C's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since December 20, 2005

1950 S COUNTRY CLUB DR, MESA, AZ 85210(480) 969-1446(480) 969-9105 Get Directions Write a Review

NPPES record last updated: June 22, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Southeast Valley Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST VALLEY MEDICAL GROUP (NPI 1649256777) is a healthcare organization registered as a family medicine in Mesa, Arizona and active in the NPI registry since December 2005. The organization lists Silvia O'leary, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1649256777

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameCOUNTRY CLUB MEDICAL GROUP P C

Location Address1950 S COUNTRY CLUB DRMesa, AZ 85210-6008

Mailing Address1950 S Country Club DrMesa, AZ 85210-6008 · (480) 969-1446 · Fax (480) 969-9105

Phone(480) 969-1446

Fax(480) 969-9105

Organization SubpartNo

Authorized OfficialSilvia O'learyOffice Manager · (480) 969-1446

Enumeration DateDecember 20, 2005

Last NPPES UpdateJune 22, 2010

✔ NPI 1649256777 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

1950 S COUNTRY CLUB DR, Mesa, AZ 85210

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Other Names 1

Doing Business AsSoutheast Valley Medical Group

Other Identifiers 2

Medicare PINZ25218AZ

Medicare ID-Type UnspecifiedCI5985AZ · Rr Medicare Grp #

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. THOMAS P PORTER M.D.

Family Medicine