Healthcare Provider Details

I. General information

NPI: 1578732814
Provider Name (Legal Business Name): AZ FAMILY CARE ASSOC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 FRONTAGE RD
SIERRA VISTA AZ
85635-4606
US

IV. Provider business mailing address

6 S. 2ND ST.
SIERRA VISTA AZ
85635-1830
US

V. Phone/Fax

Practice location:
  • Phone: 520-458-0650
  • Fax: 520-459-7030
Mailing address:
  • Phone: 520-458-4335
  • Fax: 520-458-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. FRED B WILLIAMS
Title or Position: CEO
Credential: ED.D
Phone: 520-458-4335