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General NPI Number Information
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NPI Number | 1821386400
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Entity Type | Organization
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Legal Business Name | GRAND CANYON STATE INPATIENT SERVICES
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 2174 W OAK AVE
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City | DOUGLAS
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State | AZ
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Zip | 85607-6003
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Country | US
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Telephone | 800-444-7009
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Fax | 800-305-3233
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Provider Business Mailing Address
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Address Line | 815 S PALAFOX ST SUITE 300
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City | PENSACOLA
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State | FL
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Zip | 32502-5960
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Country | US
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Telephone | 800-444-7009
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Fax | 800-305-3233
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Authorized Official
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Title or Position | EXEC. VP, EPP, GENERAL PARTNER
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Name | JOSEPH W TAYLOR
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Credential |
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Telephone | 800-444-7009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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