MEDICARE: COPPER CANYON FAMILY HEALTH CENTER

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1376816918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPPER CANYON FAMILY HEALTH CENTER

Provider Business Mailing Address
First Line	:	348 S MAIN ST
Second Line	:
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322-7155
Country	:	US
Telephone Number	:	928-214-1070
Fax Number	:	928-214-1071

Provider Business Practice Location Address
First Line	:	348 S MAIN ST
Second Line	:
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322-7155
Country	:	US
Telephone Number	:	928-214-1070
Fax Number	:	928-214-1071

Authorized Official
Title or Position	:	CEO
Name	:	DR. RONALD E PARFITT
Credential	:	MD
Telephone Number	:	928-699-5328

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	02/13/2012

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