Provider Demographics
NPI:1265502710
Name:INFECTIOUS DISEASE CENTER OF YUMA PLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CENTER OF YUMA PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-317-8118
Mailing Address - Street 1:2451 S AVENUE A STE 5
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7133
Mailing Address - Country:US
Mailing Address - Phone:928-317-8118
Mailing Address - Fax:
Practice Address - Street 1:2451 S AVENUE A STE 5
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7133
Practice Address - Country:US
Practice Address - Phone:928-317-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29333207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ588238Medicaid
AZ588238Medicaid
AZZ66863Medicare PIN