MEDICARE: NEW RIVER FAMILY MEDICINE L.L.C.

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	3297	AZ

General Provider Information

NPI Number	:	1982890851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW RIVER FAMILY MEDICINE L.L.C.

Provider Business Mailing Address
First Line	:	46641 N BLACK CANYON HWY
Second Line	:	STE 5
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-6941
Country	:	US
Telephone Number	:	623-465-8810
Fax Number	:	623-465-1561

Provider Business Practice Location Address
First Line	:	46641 N BLACK CANYON HWY
Second Line	:	STE 5
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-6941
Country	:	US
Telephone Number	:	623-465-8810
Fax Number	:	623-465-1561

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANDY CHARLES HANCOCK
Credential	:	DO
Telephone Number	:	623-465-8810

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	12/04/2007

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