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General NPI Number Information
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NPI Number | 1871922989
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Entity Type | Organization
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Legal Business Name | ARIZONA GRAND MEDICAL CENTER, PLLC
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 3773 CROSSINGS DR SUITE C
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City | PRESCOTT
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State | AZ
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Zip | 86305-7140
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Country | US
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Telephone | 928-771-9693
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Fax | 928-708-0505
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Provider Business Mailing Address
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Address Line | PO BOX 47729
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City | PHOENIX
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State | AZ
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Zip | 85068-7729
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Country | US
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Telephone | 623-934-5600
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Fax | 623-934-5603
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SATTY BHOWRA
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Credential |
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Telephone | 602-550-4065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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