Provider Demographics
NPI:1477857159
Name:YOUR HEALTH CLINIC, PLLC
Entity type:Organization
Organization Name:YOUR HEALTH CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:928-778-1566
Mailing Address - Street 1:724 N MONTEZUMA ST STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2066
Mailing Address - Country:US
Mailing Address - Phone:928-778-1566
Mailing Address - Fax:928-778-1366
Practice Address - Street 1:724 N MONTEZUMA ST STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2066
Practice Address - Country:US
Practice Address - Phone:928-778-1566
Practice Address - Fax:928-778-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN-098748261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care