Provider Demographics
NPI:1114384609
Name:WEST SEDONA FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:WEST SEDONA FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:928-204-2540
Mailing Address - Street 1:2155 W STATE ROUTE 89A
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5468
Mailing Address - Country:US
Mailing Address - Phone:928-204-2540
Mailing Address - Fax:928-204-9070
Practice Address - Street 1:2155 W STATE ROUTE 89A
Practice Address - Street 2:SUITE 113
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5468
Practice Address - Country:US
Practice Address - Phone:928-204-2540
Practice Address - Fax:928-204-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1164446043OtherINDIVIDUAL NPI
E7287ZOtherPROVIDER #
E7287ZOtherPROVIDER #