Provider Demographics
NPI:1457604019
Name:MINGUS MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:MINGUS MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:928-649-8250
Mailing Address - Street 1:214 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3907
Mailing Address - Country:US
Mailing Address - Phone:928-649-8250
Mailing Address - Fax:928-649-8255
Practice Address - Street 1:813 COVE PKWY
Practice Address - Street 2:101
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4663
Practice Address - Country:US
Practice Address - Phone:928-649-8250
Practice Address - Fax:928-649-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2192261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ968365Medicaid