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General NPI Number Information
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NPI Number | 1811872153
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Entity Type | Organization
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Legal Business Name | RED TAIL HAWK RANCH PLLC
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 3462 E LAWMAN DR
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City | KINGMAN
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State | AZ
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Zip | 86401-6591
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Country | US
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Telephone | 702-274-8220
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Fax | 928-251-8079
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Provider Business Mailing Address
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Address Line | 3462 E LAWMAN DR
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City | KINGMAN
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State | AZ
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Zip | 86401-6591
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Country | US
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Telephone | 702-274-8220
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Fax | 928-251-8079
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MICHAEL EDWARD SHEEHY
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Credential | DO
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Telephone | 702-274-8220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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