Healthcare Provider Details

I. General information

NPI: 1013666064
Provider Name (Legal Business Name): BIO FAMILY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11274 S FORTUNA RD STE I4
YUMA AZ
85367-7849
US

IV. Provider business mailing address

PO BOX 669
YUMA AZ
85366-2329
US

V. Phone/Fax

Practice location:
  • Phone: 928-247-6516
  • Fax:
Mailing address:
  • Phone: 928-247-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRI C ENGLE
Title or Position: DIRECTOR OF STAFFING & CREDENTIALIN
Credential:
Phone: 928-247-6516