Provider Demographics
NPI:1427365287
Name:GLADHART FAMILY MEDICINE
Entity Type:Organization
Organization Name:GLADHART FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLADHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-777-9600
Mailing Address - Street 1:820 AINSWORTH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1613
Mailing Address - Country:US
Mailing Address - Phone:928-777-9600
Mailing Address - Fax:928-777-9797
Practice Address - Street 1:820 AINSWORTH DR
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1613
Practice Address - Country:US
Practice Address - Phone:928-777-9600
Practice Address - Fax:928-777-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ140852Medicare PIN