Provider Demographics
NPI:1922311455
Name:CLY, CATLIN
Entity Type:Individual
Prefix:MR
First Name:CATLIN
Middle Name:
Last Name:CLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2897
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-2897
Mailing Address - Country:US
Mailing Address - Phone:928-674-5357
Mailing Address - Fax:928-674-5357
Practice Address - Street 1:1/4 E. OF MP 452 US 191
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503-2897
Practice Address - Country:US
Practice Address - Phone:928-674-5357
Practice Address - Fax:928-674-5357
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)