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General NPI Number Information
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NPI Number | 1265840037
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Entity Type | Organization
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Legal Business Name | LIFETIME MEDICAL CARE PLLC
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 01/04/2015
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Provider Practice Location Address
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Address Line | 3101 CLEARWATER DR SUITE B
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City | PRESCOTT
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State | AZ
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Zip | 86305-7180
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Country | US
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Telephone | 928-237-9014
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Fax | 928-237-9063
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Provider Business Mailing Address
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Address Line | 3101 CLEARWATER DR SUITE B
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City | PRESCOTT
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State | AZ
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Zip | 86305-7180
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Country | US
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Telephone | 928-237-9014
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Fax | 928-237-9063
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Authorized Official
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Title or Position | MANAGER/OWNER/PROVIDER
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Name | MRS. SHELLY DAMSCHRODER
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Credential | FNP
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Telephone | 928-237-9014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | AP7289
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License Number State | AZ
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