Provider Demographics
NPI:1295834604
Name:COTTONWOOD INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:COTTONWOOD INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:AVIS
Authorized Official - Last Name:FALBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-634-2692
Mailing Address - Street 1:PO BOX 2019
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326
Mailing Address - Country:US
Mailing Address - Phone:928-634-4231
Mailing Address - Fax:928-634-7867
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:STE 103
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326
Practice Address - Country:US
Practice Address - Phone:928-634-4231
Practice Address - Fax:928-634-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMDBPVMedicare ID - Type Unspecified