Provider Demographics
NPI:1962689653
Name:ARIZONA COMMUNITY HEALTH CARE LLC
Entity Type:Organization
Organization Name:ARIZONA COMMUNITY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOWALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-927-4226
Mailing Address - Street 1:PO BOX 2659
Mailing Address - Street 2:
Mailing Address - City:QUARTZSITE
Mailing Address - State:AZ
Mailing Address - Zip Code:85346-2659
Mailing Address - Country:US
Mailing Address - Phone:928-927-4226
Mailing Address - Fax:928-927-4231
Practice Address - Street 1:255 N CENTRAL BLVD
Practice Address - Street 2:STE 4
Practice Address - City:QUARTZSITE
Practice Address - State:AZ
Practice Address - Zip Code:85346
Practice Address - Country:US
Practice Address - Phone:928-927-4226
Practice Address - Fax:928-927-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ451839Medicaid