MEDICARE: ORACLE HEALTHCARE

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	:	1396900122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORACLE HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX 1270
Second Line	:
City	:	CLARKDALE
State	:	AZ
Zip	:	86324-1270
Country	:	US
Telephone Number	:	928-649-6477
Fax Number	:	928-649-2719

Provider Business Practice Location Address
First Line	:	348 S MAIN ST
Second Line	:	STE 1
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322-7155
Country	:	US
Telephone Number	:	928-649-6477
Fax Number	:	928-649-2719

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	HEATHER PETERSEN
Credential	:
Telephone Number	:	928-649-6477

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	11/19/2010

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Directions to “ORACLE HEALTHCARE ” Practice Location

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