Healthcare Provider Details

I. General information

NPI: 1043449887
Provider Name (Legal Business Name): YAVAPAI REGIONAL MEDICAL CENTER PHYSICIAN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 E FLORENTINE RD BLDG B SUITE A101
PRESCOTT VALLEY AZ
86314-2245
US

IV. Provider business mailing address

PO BOX 10880
PRESCOTT AZ
86304-0880
US

V. Phone/Fax

Practice location:
  • Phone: 928-442-8710
  • Fax: 928-442-8742
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34238
License Number StateAZ

VIII. Authorized Official

Name: MR. MATT RICE
Title or Position: CFO
Credential:
Phone: 928-445-2700