Healthcare Provider Details

I. General information

NPI: 1124566559
Provider Name (Legal Business Name): SPECTRUM HEALTHCARE GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 W FINNIE FLAT RD STE F
CAMP VERDE AZ
86322-7379
US

IV. Provider business mailing address

8 E COTTONWOOD ST
COTTONWOOD AZ
86326-4382
US

V. Phone/Fax

Practice location:
  • Phone: 776-347-3338
  • Fax: 866-984-3891
Mailing address:
  • Phone: 877-634-7333
  • Fax: 866-984-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CORINNE BAILEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 877-634-7333