MEDICARE: PRESCOTT CARDIOLOGY, PC

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician
2	174400000X	Specialist	26235	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902858533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCOTT CARDIOLOGY, PC

Provider Business Mailing Address
First Line	:	804 AINSWORTH DR
Second Line	:	SUITE 102
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1624
Country	:	US
Telephone Number	:	928-776-0601
Fax Number	:	928-776-0620

Provider Business Practice Location Address
First Line	:	804 AINSWORTH DR
Second Line	:	SUITE 102
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1624
Country	:	US
Telephone Number	:	928-776-0601
Fax Number	:	928-776-0620

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	MR. DOUGLAS WAYNE ROTHROCK
Credential	:	M.D.
Telephone Number	:	928-776-0601

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	11/17/2016

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Directions to “PRESCOTT CARDIOLOGY, PC ” Practice Location

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