Provider Demographics
NPI:1578766655
Name:ARIZONA GRAND MEDICAL CENTER
Entity Type:Organization
Organization Name:ARIZONA GRAND MEDICAL CENTER
Other - Org Name:PRESCOTT HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOWRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-200-8988
Mailing Address - Street 1:PO BOX 47729
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068
Mailing Address - Country:US
Mailing Address - Phone:602-200-8988
Mailing Address - Fax:
Practice Address - Street 1:1590 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1141
Practice Address - Country:US
Practice Address - Phone:928-771-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID