Provider Demographics
NPI:1205309812
Name:PRIORITY FAMILY MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:PRIORITY FAMILY MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JUDAH
Authorized Official - Last Name:GANN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:928-277-0875
Mailing Address - Street 1:3165 STILLWATER DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7173
Mailing Address - Country:US
Mailing Address - Phone:928-277-0875
Mailing Address - Fax:
Practice Address - Street 1:3165 STILLWATER DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7173
Practice Address - Country:US
Practice Address - Phone:928-277-0875
Practice Address - Fax:928-379-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty