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General NPI Number Information
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NPI Number | 1770664641
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Entity Type | Organization
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Legal Business Name | SOUTHWESTERN MEDICAL CENTERS-AZ, INC.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 860 DOUGHERTY ST
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City | PRESCOTT
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State | AZ
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Zip | 86305-1841
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Country | US
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Telephone | 928-778-9777
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Fax | 928-717-0587
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Provider Business Mailing Address
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Address Line | 1020 NE LOOP 410 SUITE 640
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1204
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Country | US
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Telephone | 210-828-5686
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Fax | 210-824-4669
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | STAN STUDER JR.
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Credential |
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Telephone | 210-828-5686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALC-4785
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License Number State | AZ
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