MEDICARE: THE FAMILY DOCTOR, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	47138	AZ

General Provider Information

NPI Number	:	1063825503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY DOCTOR, PLLC

Provider Business Mailing Address
First Line	:	1670 N KOLB RD STE 146
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-4941
Country	:	US
Telephone Number	:	520-777-1973
Fax Number	:	520-300-7090

Provider Business Practice Location Address
First Line	:	1670 N KOLB RD STE 146
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-4941
Country	:	US
Telephone Number	:	520-777-1973
Fax Number	:	520-300-7090

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL KARTCHNER
Credential	:
Telephone Number	:	520-777-1973

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	10/13/2022

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