=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063660025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YAVAPAI REGIONAL MEDICAL CENTER PHYSICIAN CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2008
-----------------------------------------------------
Last Update Date | 12/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1003 WILLOW CREEK RD
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86301-1641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-848-3685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1003 WILLOW CREEK RD
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86301-1641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-848-3685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. TIMOTHY BARNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-848-3685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------