Provider Demographics
NPI:1346439106
Name:SEDONA FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:SEDONA FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:928-282-0005
Mailing Address - Street 1:1890 W HWY 89A
Mailing Address - Street 2:STE. D
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5571
Mailing Address - Country:US
Mailing Address - Phone:928-282-0005
Mailing Address - Fax:928-282-0007
Practice Address - Street 1:1890 W HWY 89A
Practice Address - Street 2:STE. D
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5571
Practice Address - Country:US
Practice Address - Phone:928-282-0005
Practice Address - Fax:928-282-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN039875261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care