Healthcare Provider Details

I. General information

NPI: 1427224443
Provider Name (Legal Business Name): ARIZONA GRAND MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 E FLORENTINE RD
PRESCOTT VALLEY AZ
86314-2218
US

IV. Provider business mailing address

PO BOX 47729
PHOENIX AZ
85068-7729
US

V. Phone/Fax

Practice location:
  • Phone: 928-632-1155
  • Fax: 928-632-8295
Mailing address:
  • Phone: 602-550-4065
  • Fax: 623-934-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SATTY BHOWRA
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-550-4065