Healthcare Provider Details

I. General information

NPI: 1003008889
Provider Name (Legal Business Name): MEDICAL CLINIC OF OAK CREEK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W HWY 89A STE 107
SEDONA AZ
86336
US

IV. Provider business mailing address

2301 W HWY 89A STE 107
SEDONA AZ
86336
US

V. Phone/Fax

Practice location:
  • Phone: 928-203-9013
  • Fax: 928-203-9016
Mailing address:
  • Phone: 928-203-9013
  • Fax: 928-203-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number93437
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number93437
License Number StateAZ

VIII. Authorized Official

Name: DR. JAMES M HUTTON JR.
Title or Position: DIRECTOR
Credential: NMD
Phone: 928-203-9013