Healthcare Provider Details

I. General information

NPI: 1568469906
Provider Name (Legal Business Name): PARKER MEDICAL CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 FIESTA
PARKER AZ
85344-5152
US

IV. Provider business mailing address

905 FIESTA
PARKER AZ
85344-5152
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-2225
  • Fax: 928-669-6751
Mailing address:
  • Phone: 928-669-2225
  • Fax: 928-669-6751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number32755
License Number StateAZ

VIII. Authorized Official

Name: ALICIA ANN SHILLITO
Title or Position: OFFICE MANAGER
Credential:
Phone: 928-669-2225