Provider Demographics
NPI:1558387845
Name:TWIN PEAKS MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:TWIN PEAKS MEDICAL ASSOCIATES PLLC
Other - Org Name:FASTRAX URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PHYSICIAN PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-753-3303
Mailing Address - Street 1:2002 N STOCKTON HILL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4698
Mailing Address - Country:US
Mailing Address - Phone:928-753-3303
Mailing Address - Fax:928-753-3603
Practice Address - Street 1:2002 N STOCKTON HILL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4698
Practice Address - Country:US
Practice Address - Phone:928-753-3303
Practice Address - Fax:928-753-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3597261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ850166Medicaid
AZ850166Medicaid