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General NPI Number Information
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NPI Number | 1558387845
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Entity Type | Organization
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Legal Business Name | TWIN PEAKS MEDICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 2002 N STOCKTON HILL RD SUITE 103
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City | KINGMAN
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State | AZ
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Zip | 86401-4698
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Country | US
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Telephone | 928-753-3303
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Fax | 928-753-3603
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Provider Business Mailing Address
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Address Line | 2002 N STOCKTON HILL RD SUITE 103
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City | KINGMAN
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State | AZ
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Zip | 86401-4698
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Country | US
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Telephone | 928-753-3303
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Fax | 928-753-3603
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Authorized Official
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Title or Position | MANAGING PHYSICIAN PARTNER
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Name | MR. DONOVAN SCHMIDT
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Credential | DO
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Telephone | 928-753-3303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | OTC3597
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License Number State | AZ
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