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General NPI Number Information
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NPI Number | 1972841146
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Entity Type | Organization
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Legal Business Name | ARIZONA EM-1 MEDICAL SERVICES, PC
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 520 ROSE LN WICKENBURG COMMUNITY HOSPITAL
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City | WICKENBURG
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State | AZ
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Zip | 85390-1447
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Country | US
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Telephone | 928-684-5421
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Fax |
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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 | OWNER
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Name | DR. DONALD T GODBOLD
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Credential | M.D.
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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