Provider Demographics
NPI:1902846785
Name:SEDONA URGENT CARE, LTD.
Entity Type:Organization
Organization Name:SEDONA URGENT CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:S
Authorized Official - Last Name:TEKELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-203-4813
Mailing Address - Street 1:2530 W HWY 89A
Mailing Address - Street 2:BLDG A
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5256
Mailing Address - Country:US
Mailing Address - Phone:928-203-4813
Mailing Address - Fax:928-203-0201
Practice Address - Street 1:2530 W HWY 89A
Practice Address - Street 2:BLDG A
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5256
Practice Address - Country:US
Practice Address - Phone:928-203-4813
Practice Address - Fax:928-203-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC2736261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ544800Medicaid
AZ544800Medicaid