Healthcare Provider Details

I. General information

NPI: 1871721688
Provider Name (Legal Business Name): NEW RIVER FAMILY PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46641 N BLACK CANYON HWY #5
NEW RIVER AZ
85087-6941
US

IV. Provider business mailing address

46641 N BLACK CANYON HWY #5
NEW RIVER AZ
85087-6941
US

V. Phone/Fax

Practice location:
  • Phone: 623-465-8810
  • Fax: 623-465-1561
Mailing address:
  • Phone: 623-465-8810
  • Fax: 623-465-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4359
License Number StateAZ

VIII. Authorized Official

Name: DR. STEPHEN CURTIS HAMMETT
Title or Position: OWNER
Credential: D.O.
Phone: 623-465-8810