Provider Demographics
NPI:1659513760
Name:DR. JOHN R. MARKHAM PC
Entity Type:Organization
Organization Name:DR. JOHN R. MARKHAM PC
Other - Org Name:PRESCOTT VISION & EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-778-3950
Mailing Address - Street 1:1680 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1108
Mailing Address - Country:US
Mailing Address - Phone:928-778-3950
Mailing Address - Fax:928-778-3999
Practice Address - Street 1:25 W YAVAPAI ST
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-3280
Practice Address - Country:US
Practice Address - Phone:928-684-2880
Practice Address - Fax:928-684-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4498207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z6546OtherHEALTH NET
AZNNP12599OtherUNIVERSAL HEALTH CARE
AZ033176-001OtherMERCYCARE
AZ190721OtherAHCCCS
AZ190721Medicaid
AZ3421045OtherCIGNA
AZ572818OtherRAN-AMN
AZAZ01170OtherMEDICARE SUBMITTER ID
AZ7742967OtherAETNA
AZ866291-9714OtherHUMANA
AZ033176-001OtherMERCYCARE