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General NPI Number Information
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NPI Number | 1508816257
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Entity Type | Organization
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Legal Business Name | MEDICAL SERVICES OF PRESCOTT, INC.
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 1003 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1641
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Country | US
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Telephone | 928-771-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 WILLOW CREEK RD STE. 101, PMB 521
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City | PRESCOTT
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State | AZ
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Zip | 86301-1673
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Country | US
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Telephone | 928-771-5100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTIN F DEKORT
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Credential | MD
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Telephone | 928-771-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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