Provider Demographics
NPI:1376816918
Name:COPPER CANYON FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:COPPER CANYON FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARFITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-699-5328
Mailing Address - Street 1:348 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-7155
Mailing Address - Country:US
Mailing Address - Phone:928-214-1070
Mailing Address - Fax:928-214-1071
Practice Address - Street 1:348 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7155
Practice Address - Country:US
Practice Address - Phone:928-214-1070
Practice Address - Fax:928-214-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty