Provider Demographics
NPI:1073680468
Name:COLORADO RIVER FAMILY HEALTHCARE, PC
Entity Type:Organization
Organization Name:COLORADO RIVER FAMILY HEALTHCARE, PC
Other - Org Name:MELINDA ASTRAN, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-669-6700
Mailing Address - Street 1:601 W RIVERSIDE DR
Mailing Address - Street 2:STE. 3 & 4
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5119
Mailing Address - Country:US
Mailing Address - Phone:928-669-6700
Mailing Address - Fax:928-669-6709
Practice Address - Street 1:601 W RIVERSIDE DR
Practice Address - Street 2:STE. 3 & 4
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5119
Practice Address - Country:US
Practice Address - Phone:928-669-6700
Practice Address - Fax:928-669-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34058261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00296621OtherRAILROAD MEDICARE
AZ34058OtherMEDICAL LICENSE
AZP00296621OtherRAILROAD MEDICARE
AZH92386Medicare UPIN