Provider Demographics
NPI:1821759630
Name:INTIMATE HEALTH TELEMEDICINE LLC
Entity Type:Organization
Organization Name:INTIMATE HEALTH TELEMEDICINE LLC
Other - Org Name:SHOW LOW FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:ZELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:425-244-4303
Mailing Address - Street 1:1500 S WHITE MOUNTAIN RD STE 401B
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7117
Mailing Address - Country:US
Mailing Address - Phone:928-251-2914
Mailing Address - Fax:
Practice Address - Street 1:1500 S WHITE MOUNTAIN RD STE 401B
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7117
Practice Address - Country:US
Practice Address - Phone:928-251-2914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty