Healthcare Provider Details

I. General information

NPI: 1649262965
Provider Name (Legal Business Name): PHYSICIAN BUSINESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-2248
US

IV. Provider business mailing address

3051 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-2248
US

V. Phone/Fax

Practice location:
  • Phone: 928-772-3336
  • Fax: 928-772-3363
Mailing address:
  • Phone: 928-772-3336
  • Fax: 928-772-3363

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: MR. DIETER W. KRANTZ
Title or Position: VICE PRESIDENT
Credential:
Phone: 928-772-2591