Healthcare Provider Details

I. General information

NPI: 1376976969
Provider Name (Legal Business Name): PINAL COUNTY ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E MAIN ST
SUPERIOR AZ
85173
US

IV. Provider business mailing address

PO BOX 2945
FLORENCE AZ
85132-3055
US

V. Phone/Fax

Practice location:
  • Phone: 520-866-7319
  • Fax: 520-866-7066
Mailing address:
  • Phone: 520-866-7319
  • Fax: 520-866-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberOTC3851
License Number StateAZ

VIII. Authorized Official

Name: SUSIE C ESCALANTE
Title or Position: ACCOUNT CLERK-BILLING
Credential:
Phone: 520-866-7319