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General NPI Number Information
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NPI Number | 1447096417
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Entity Type | Organization
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Legal Business Name | AJMEDICUS
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Dates
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Enumeration Date | 07/08/2024
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 1467 PALMA RD STE 4
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-6785
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Country | US
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Telephone | 561-573-8521
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Fax |
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Provider Business Mailing Address
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Address Line | 1846 E INNOVATION PARK DR STE 100
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City | ORO VALLEY
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State | AZ
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Zip | 85755-1963
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Country | US
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Telephone | 561-573-8521
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Fax |
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Authorized Official
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Title or Position | PROVIDER, MANAGER
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Name | SAMUEL JOSEPH
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Credential | PA-C
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Telephone | 561-573-8521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult 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 | 208D00000X
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Taxonomy Name | General Practice 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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