Provider Demographics
NPI:1265700793
Name:CHRISTOPHER WARREN
Entity type:Organization
Organization Name:CHRISTOPHER WARREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-282-3535
Mailing Address - Street 1:55 SHELBY DR
Mailing Address - Street 2:A3
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5300
Mailing Address - Country:US
Mailing Address - Phone:928-282-3535
Mailing Address - Fax:928-282-1107
Practice Address - Street 1:55 SHELBY DR
Practice Address - Street 2:A3
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5300
Practice Address - Country:US
Practice Address - Phone:928-282-3535
Practice Address - Fax:928-282-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20757067332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies