Provider Demographics
NPI:1710165014
Name:YUMA AMBULATORY INFUSION CENTER
Entity Type:Organization
Organization Name:YUMA AMBULATORY INFUSION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-344-3350
Mailing Address - Street 1:2270 S RIDGEVIEW DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8875
Mailing Address - Country:US
Mailing Address - Phone:928-783-4038
Mailing Address - Fax:928-782-3822
Practice Address - Street 1:2270 S RIDGEVIEW DR
Practice Address - Street 2:STE 130
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8875
Practice Address - Country:US
Practice Address - Phone:928-783-4038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19608261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ123610Medicare PIN