Provider Demographics
NPI:1497803928
Name:INTERMED INC
Entity Type:Organization
Organization Name:INTERMED INC
Other - Org Name:SEDONA FAMILY MEDICAL AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAFARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-204-9393
Mailing Address - Street 1:2050 YAVAPAI DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4558
Mailing Address - Country:US
Mailing Address - Phone:928-204-9393
Mailing Address - Fax:928-204-9292
Practice Address - Street 1:2050 YAVAPAI DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4558
Practice Address - Country:US
Practice Address - Phone:928-204-9393
Practice Address - Fax:928-204-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104669Medicare PIN
AZG02957Medicare UPIN