Provider Demographics
NPI:1639475783
Name:PHYSICIAN BUSINESS SERIVCES, LLC
Entity Type:Organization
Organization Name:PHYSICIAN BUSINESS SERIVCES, LLC
Other - Org Name:PRESCOTT VALLEY PRIMARY & URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-772-3336
Mailing Address - Street 1:3051 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2248
Mailing Address - Country:US
Mailing Address - Phone:928-772-3336
Mailing Address - Fax:928-772-1148
Practice Address - Street 1:3051 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2248
Practice Address - Country:US
Practice Address - Phone:928-772-3336
Practice Address - Fax:928-772-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3025261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ553653Medicaid
AZZ64419Medicare PIN