Provider Demographics
NPI:1477722718
Name:ARIZONA FAMILY CARE ASSOCIATES, INC
Entity Type:Organization
Organization Name:ARIZONA FAMILY CARE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:520-458-4335
Mailing Address - Street 1:6 S. 2ND ST.
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-1830
Mailing Address - Country:US
Mailing Address - Phone:520-458-4335
Mailing Address - Fax:520-458-2988
Practice Address - Street 1:1101 SAN ANTONIO AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-364-7544
Practice Address - Fax:520-364-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0414710004Medicare NSC
AZWCKMCMedicare PIN