Healthcare Provider Details

I. General information

NPI: 1194893032
Provider Name (Legal Business Name): STAUFFER PLUMBING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 QUAIL RIDGE RD.
GLOBE AZ
85501
US

IV. Provider business mailing address

PO BOX 1066
CLAYPOOL AZ
85532-1066
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-8472
  • Fax: 928-402-1082
Mailing address:
  • Phone: 928-425-8472
  • Fax: 928-402-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberROC215990
License Number StateAZ

VIII. Authorized Official

Name: MAT STAUFFER SR.
Title or Position: 0WNER
Credential:
Phone: 928-425-8472