Healthcare Provider Details

I. General information

NPI: 1073920484
Provider Name (Legal Business Name): YAVAPAI REGIONAL MEDICAL CENTER PHYSICIAN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 GAIL GARDNER WAY SUITE B
PRESCOTT AZ
86305-2314
US

IV. Provider business mailing address

PO BOX 10880
PRESCOTT AZ
86304-0880
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-0304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH CAMACHO
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 928-445-3319