Provider Demographics
NPI:1740399633
Name:YUMA PRIMARY CARE P L L C
Entity Type:Organization
Organization Name:YUMA PRIMARY CARE P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEHATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-726-7171
Mailing Address - Street 1:PO BOX 5089
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-5089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:928-726-7206
Practice Address - Street 1:1881 W 24TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6297
Practice Address - Country:US
Practice Address - Phone:928-726-7171
Practice Address - Fax:928-726-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ945876Medicaid
AZ03D1051477OtherCLIA
AZP00275055OtherRAIL ROAD MEDICARE
AZ03D1051477OtherCLIA
AZ945876Medicaid