Provider Demographics
NPI:1235721531
Name:COLTON HEALTH AZ, LLC
Entity Type:Organization
Organization Name:COLTON HEALTH AZ, LLC
Other - Org Name:AZ CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUKHJIT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:GHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-609-4200
Mailing Address - Street 1:1755 AIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3620
Mailing Address - Country:US
Mailing Address - Phone:480-553-6263
Mailing Address - Fax:
Practice Address - Street 1:890 AIRWAY AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3588
Practice Address - Country:US
Practice Address - Phone:928-681-1234
Practice Address - Fax:928-681-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site