Provider Demographics
NPI:1568469906
Name:PARKER MEDICAL CENTER, LTD.
Entity Type:Organization
Organization Name:PARKER MEDICAL CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHILLITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-669-2225
Mailing Address - Street 1:905 FIESTA
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5152
Mailing Address - Country:US
Mailing Address - Phone:928-669-2225
Mailing Address - Fax:928-669-6751
Practice Address - Street 1:905 FIESTA
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5152
Practice Address - Country:US
Practice Address - Phone:928-669-2225
Practice Address - Fax:928-669-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32755207QA0505X
AZ261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ862690Medicaid
77384Medicare ID - Type Unspecified
AZ862690Medicaid
AZ033836Medicare Oscar/Certification