Provider Demographics
NPI: | 1265462006 |
---|---|
Name: | ARIZONA FAMILY CARE ASSOCIATES, INC. |
Entity Type: | Organization |
Organization Name: | ARIZONA FAMILY CARE ASSOCIATES, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | FRED |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | WILLIAMS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | ED D |
Authorized Official - Phone: | 520-458-4335 |
Mailing Address - Street 1: | 302 EL CAMINO REAL |
Mailing Address - Street 2: | STE 5 |
Mailing Address - City: | SIERRA VISTA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85635-2860 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 520-458-4335 |
Mailing Address - Fax: | 520-452-2232 |
Practice Address - Street 1: | 302 EL CAMINO REAL |
Practice Address - Street 2: | #5 |
Practice Address - City: | SIERRA VISTA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85635-2860 |
Practice Address - Country: | US |
Practice Address - Phone: | 520-458-4335 |
Practice Address - Fax: | 520-452-2232 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-04 |
Last Update Date: | 2010-10-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207Q00000X, 207R00000X, 207RP1001X, 207V00000X, 207X00000X, 208000000X, 2084N0400X, 2084P2900X, 2085B0100X, 2085R0202X, 2085U0001X, 208600000X | ||
AZ | 0414710002 | 332B00000X |
AZ | 0414710004 | 332B00000X |
AZ | 0414710003 | 332B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P2900X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine | Group - Multi-Specialty |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | DB9495 | Other | MEDICARE RAILROAD |
AZ | C40354 | Other | MEDICARE RAILROAD |
AZ | CF8118 | Other | MEDICARE RAILROAD |
AZ | DB9495 | Other | MEDICARE RAILROAD |
AZ | ZWCKMG | Medicare PIN | |
AZ | ZWCKMH | Medicare PIN |