Provider Demographics
NPI:1770836512
Name:CHOICES INTEGRATIVE HEALTCARE OF SEDONA
Entity type:Organization
Organization Name:CHOICES INTEGRATIVE HEALTCARE OF SEDONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-203-4357
Mailing Address - Street 1:95 SOLDIERS PASS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4781
Mailing Address - Country:US
Mailing Address - Phone:928-203-4357
Mailing Address - Fax:928-203-4497
Practice Address - Street 1:95 SOLDIERS PASS RD
Practice Address - Street 2:SUITE B
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4781
Practice Address - Country:US
Practice Address - Phone:928-203-4357
Practice Address - Fax:928-203-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27754Medicare UPIN