Provider Demographics
NPI:1083946610
Name:SHIRLEY RHEINFELDER PLLC
Entity Type:Organization
Organization Name:SHIRLEY RHEINFELDER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-778-1251
Mailing Address - Street 1:47 N FRENCH DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6247
Mailing Address - Country:US
Mailing Address - Phone:928-778-1251
Mailing Address - Fax:928-778-7834
Practice Address - Street 1:3149 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2240
Practice Address - Country:US
Practice Address - Phone:928-445-6083
Practice Address - Fax:928-775-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ774762Medicaid
AZAZ0734010OtherBCBS
AZZ74731OtherMEDICARE ID-TYPE UNSPECIFIED
AZZ74731OtherMEDICARE ID-TYPE UNSPECIFIED