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General NPI Number Information
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NPI Number | 1558548487
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE SPECIALISTS OF PRESCOTT VALLEY ARIZONA,PC
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 3223 N WINDSONG DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1222
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Country | US
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Telephone | 928-772-1845
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Fax | 928-772-1844
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Provider Business Mailing Address
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Address Line | 3223 N WINDSONG DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1222
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Country | US
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Telephone | 928-772-1845
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Fax | 928-772-1844
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARRY LAVERN GALE
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Credential | DO
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Telephone | 928-772-1845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2772
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License Number State | AZ
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