Provider Demographics
NPI:1629252945
Name:REPLOGLE MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:REPLOGLE MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:REPLOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-342-9020
Mailing Address - Street 1:11871 S FORTUNA RD
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-7686
Mailing Address - Country:US
Mailing Address - Phone:928-342-9020
Mailing Address - Fax:928-342-2158
Practice Address - Street 1:11871 S FORTUNA RD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7686
Practice Address - Country:US
Practice Address - Phone:928-342-9020
Practice Address - Fax:928-342-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2757261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care