Provider Demographics
NPI:1073986923
Name:PAINTED DESERT PRIMARY CARE & GYNECOLOGY PC
Entity Type:Organization
Organization Name:PAINTED DESERT PRIMARY CARE & GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORCHERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-704-4336
Mailing Address - Street 1:2020 SILVER CREEK RD
Mailing Address - Street 2:BLDG. B, STE. 101A
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8476
Mailing Address - Country:US
Mailing Address - Phone:928-704-4336
Mailing Address - Fax:928-704-0410
Practice Address - Street 1:2020 SILVER CREEK RD
Practice Address - Street 2:BLDG. B, STE. 101A
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8476
Practice Address - Country:US
Practice Address - Phone:928-704-4336
Practice Address - Fax:928-704-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-01
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3681207VG0400X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20420279OtherARIZONA CORPORATION FILE #