Provider Demographics
NPI: | 1619277944 |
---|---|
Name: | EMERGENCY MEDICINE PHYSICIANS OF YAVAPAI COUNTY, PLLC |
Entity Type: | Organization |
Organization Name: | EMERGENCY MEDICINE PHYSICIANS OF YAVAPAI COUNTY, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PACKO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 330-493-4443 |
Mailing Address - Street 1: | 4535 DRESSLER RD NW |
Mailing Address - Street 2: | |
Mailing Address - City: | CANTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44718-2545 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-493-4443 |
Mailing Address - Fax: | 330-451-4032 |
Practice Address - Street 1: | 3700 W STATE ROUTE 89A |
Practice Address - Street 2: | |
Practice Address - City: | SEDONA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 86336-4937 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-493-4443 |
Practice Address - Fax: | 330-451-4032 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-11-03 |
Last Update Date: | 2013-01-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Single Specialty |