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General NPI Number Information
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NPI Number | 1508072844
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Entity Type | Organization
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Legal Business Name | MOUNT GRAHAM FAMILY MEDICINE PRACTICE,P.C.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 1300 S. 20TH AVENUE
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City | SAFFORD
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State | AZ
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Zip | 85546
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Country | US
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Telephone | 928-428-3122
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Fax | 928-428-7917
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Provider Business Mailing Address
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Address Line | 1300 S. 20TH AVENUE
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City | SAFFORD
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State | AZ
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Zip | 85546
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Country | US
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Telephone | 928-428-3122
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Fax | 928-428-7917
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN J KARTCHNER
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Credential | MD
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Telephone | 928-428-3122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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