Provider Demographics
NPI:1578732814
Name:AZ FAMILY CARE ASSOC INC.
Entity Type:Organization
Organization Name:AZ FAMILY CARE ASSOC 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:EDD
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 1:1951 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4606
Practice Address - Country:US
Practice Address - Phone:520-458-0650
Practice Address - Fax:520-459-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0414710003Medicare NSC
AZZWCKMGMedicare PIN