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General NPI Number Information
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NPI Number | 1740767664
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Entity Type | Organization
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Legal Business Name | GILA VALLEY CLINIC PC
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 1680 S 20TH AVE
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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 | 928-428-1377
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Fax | 928-428-6903
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Provider Business Mailing Address
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Address Line | 1680 S 20TH AVE
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City | SAFFORD
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State | AZ
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Zip | 85546-4011
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Country | US
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Telephone | 928-428-1377
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | DONNA S. COCA
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Credential |
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Telephone | 928-428-1377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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