Provider Demographics
NPI:1790961167
Name:CARNETT CLINIC, LLC
Entity Type:Organization
Organization Name:CARNETT CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:CARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-439-5186
Mailing Address - Street 1:4990 E MEDITERRANEAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2495
Mailing Address - Country:US
Mailing Address - Phone:520-439-5186
Mailing Address - Fax:520-439-4466
Practice Address - Street 1:4990 E MEDITERRANEAN DR STE A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2495
Practice Address - Country:US
Practice Address - Phone:520-439-5186
Practice Address - Fax:520-439-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3174207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102181Medicare PIN