MEDICARE: RED TAIL HAWK RANCH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083A0300X	Addiction Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1811872153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED TAIL HAWK RANCH PLLC

Provider Business Mailing Address
First Line	:	3462 E LAWMAN DR
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-6591
Country	:	US
Telephone Number	:	702-274-8220
Fax Number	:	928-251-8079

Provider Business Practice Location Address
First Line	:	3462 E LAWMAN DR
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-6591
Country	:	US
Telephone Number	:	702-274-8220
Fax Number	:	928-251-8079

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MICHAEL EDWARD SHEEHY
Credential	:	DO
Telephone Number	:	702-274-8220

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	04/28/2026

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