Healthcare Provider Details

I. General information

NPI: 1427060896
Provider Name (Legal Business Name): DAVIS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S 6TH ST
COTTONWOOD AZ
86326-4237
US

IV. Provider business mailing address

55 S 6TH ST
COTTONWOOD AZ
86326-4237
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-5118
  • Fax: 928-634-8522
Mailing address:
  • Phone: 928-634-5118
  • Fax: 928-634-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2222
License Number StateAZ

VIII. Authorized Official

Name: PAUL H QUINTERO
Title or Position: MANAGER
Credential:
Phone: 928-634-5118