MEDICARE: PRESCOTT COMPLETE CARE, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208D00000X	General Practice Physician
2	363AM0700X	Medical Physician Assistant
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1538714092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCOTT COMPLETE CARE, PLLC

Provider Business Mailing Address
First Line	:	1947 COMMERCE CENTER CIRCLE
Second Line	:	SUITE A
City	:	PRESCOTT
State	:	AZ
Zip	:	86301
Country	:	US
Telephone Number	:	928-458-5723
Fax Number	:	928-237-1787

Provider Business Practice Location Address
First Line	:	1947 COMMERCE CENTER CIRCLE
Second Line	:	SUITE A
City	:	PRESCOTT
State	:	AZ
Zip	:	86301
Country	:	US
Telephone Number	:	928-458-5723
Fax Number	:	928-237-1787

Authorized Official
Title or Position	:	MEMBER
Name	:	JOSEPH VICCICA
Credential	:
Telephone Number	:	570-299-0037

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	04/07/2026

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