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General NPI Number Information
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NPI Number | 1043454242
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Entity Type | Organization
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Legal Business Name | VERDE VALLEY CONNECTION PRIMARY CARE PLC
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 8 E COTTONWOOD ST BLDG C
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4382
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Country | US
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Telephone | 928-203-5400
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Fax | 928-634-2841
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Provider Business Mailing Address
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Address Line | 8 E COTTONWOOD ST BLDG C
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4382
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Country | US
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Telephone | 928-203-5400
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Fax | 928-634-2841
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Authorized Official
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Title or Position | MEMBER
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Name | MR. LANCE FISHER
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Credential | PA-C
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Telephone | 928-634-2574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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