MEDICARE: COUNTY OF YAVAPAI

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	251K00000X	Public Health or Welfare Agency	OTC0367	AZ

General Provider Information

NPI Number	:	1740306307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF YAVAPAI

Provider Business Mailing Address
First Line	:	1090 COMMERCE DR
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-3700
Country	:	US
Telephone Number	:	928-583-1000
Fax Number	:	866-323-8458

Provider Business Practice Location Address
First Line	:	51 BRIAN MICKELSEN PARKWAY
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-3610
Country	:	US
Telephone Number	:	928-639-8132
Fax Number	:	866-279-8919

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHARON RICKMAN
Credential	:
Telephone Number	:	928-442-5285

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	02/10/2017

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Directions to “COUNTY OF YAVAPAI ” Practice Location

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