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General NPI Number Information
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NPI Number | 1043575483
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Entity Type | Organization
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Legal Business Name | SIERRA VISTA REGIONAL HEALTH CENTER MEDICAL GROUP LLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 5750 E HIGHWAY 90 SUITE 200
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City | SIERRA VISTA
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State | AZ
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Zip | 85635
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Country | US
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Telephone | 520-263-3979
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Fax | 520-263-3977
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Provider Business Mailing Address
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Address Line | 5750 E HIGHWAY 90 SUITE 200
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-9111
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Country | US
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Telephone | 520-263-3979
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Fax | 520-263-3977
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Authorized Official
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Title or Position | SECRETARY
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Name | CHARLOTTE LAWRENCE
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Credential |
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Telephone | 615-920-7000
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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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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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