Healthcare Provider Details

I. General information

NPI: 1932572815
Provider Name (Legal Business Name): YAVAPAI REGIONAL MEDICAL CENTER PHYSICIAN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3262 N WINDSONG DR STE 2A
PRESCOTT VALLEY AZ
86314-2255
US

IV. Provider business mailing address

PO BOX 10880
PRESCOTT AZ
86304-0880
US

V. Phone/Fax

Practice location:
  • Phone: 928-759-5987
  • Fax: 928-458-2039
Mailing address:
  • Phone: 928-759-5987
  • Fax: 928-458-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: ELIZABETH CAMACHO
Title or Position: REVENUE CYCLE MANAGER
Credential: RCM
Phone: 928-759-5987