Provider Demographics
NPI:1710170642
Name:LISA MARIE YORK, MD
Entity Type:Organization
Organization Name:LISA MARIE YORK, MD
Other - Org Name:PINE STRAWBERRY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-476-3258
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:PINE
Mailing Address - State:AZ
Mailing Address - Zip Code:85544-0409
Mailing Address - Country:US
Mailing Address - Phone:928-476-3258
Mailing Address - Fax:928-476-3186
Practice Address - Street 1:6152 HARDSCRABBLE ROAD
Practice Address - Street 2:
Practice Address - City:PINE
Practice Address - State:AZ
Practice Address - Zip Code:85544
Practice Address - Country:US
Practice Address - Phone:928-476-3258
Practice Address - Fax:928-476-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391186Medicaid
AZAZ0740060OtherBLUE CROSS BLUE SHIELD
AZ1Z9017OtherHEALTHNET
AZAZ0740060OtherBLUE CROSS BLUE SHIELD
G60749Medicare UPIN