Provider Demographics
NPI:1699831271
Name:RICHARD A ADAMS MD PC
Entity Type:Organization
Organization Name:RICHARD A ADAMS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-634-4555
Mailing Address - Street 1:PO BOX 2229
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2229
Mailing Address - Country:US
Mailing Address - Phone:928-634-4555
Mailing Address - Fax:928-634-4556
Practice Address - Street 1:20 E STATE ROUTE 89A STE 102
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4110
Practice Address - Country:US
Practice Address - Phone:928-639-5565
Practice Address - Fax:928-639-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16375261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0887020OtherBCBS
AZ259087-03Medicaid
AZZ65450Medicare ID - Type Unspecified
AZ259087-03Medicaid