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General NPI Number Information
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NPI Number | 1558413781
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Entity Type | Organization
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Legal Business Name | CHERRY FAMILY PRACTICE, PLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 411 S 14TH ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3478
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Country | US
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Telephone | 928-634-2574
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Fax | 928-634-2841
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Provider Business Mailing Address
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Address Line | 411 S 14TH ST PO BOX 1860
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3478
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Country | US
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Telephone | 928-634-2574
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Fax | 928-634-2841
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SCOTT D BINGHAM
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Credential | D.O.
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Telephone | 602-228-6242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2919AZ
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License Number State | AZ
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