Healthcare Provider Details

I. General information

NPI: 1518299585
Provider Name (Legal Business Name): JAMES SHEA CONNOLLY RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9406 S. LEON RANCH ROAD
VAIL AZ
85641
US

IV. Provider business mailing address

PO BOX 674
VAIL AZ
85641-0674
US

V. Phone/Fax

Practice location:
  • Phone: 520-551-9011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number2727
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: