Healthcare Provider Details

I. General information

NPI: 1386363638
Provider Name (Legal Business Name): EXCEPTIONAL PHYSICIANS GROUP YUMA HOSPITAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 SOUTH ARABY ROAD
YUMA AZ
85365
US

IV. Provider business mailing address

PO BOX 191308
DALLAS TX
75219-8308
US

V. Phone/Fax

Practice location:
  • Phone: 469-341-7800
  • Fax:
Mailing address:
  • Phone: 469-341-7800
  • Fax: 469-341-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD IVAN COLLINS
Title or Position: FINANCIAL SYSTEM ADVISOR
Credential:
Phone: 972-888-7216