Provider Demographics
NPI:1801812219
Name:JON C SCHWARTZ MD PC
Entity type:Organization
Organization Name:JON C SCHWARTZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-681-6100
Mailing Address - Street 1:3931 STOCKTON HILL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3001
Mailing Address - Country:US
Mailing Address - Phone:928-681-6100
Mailing Address - Fax:928-681-6103
Practice Address - Street 1:3931 STOCKTON HILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3001
Practice Address - Country:US
Practice Address - Phone:928-681-6100
Practice Address - Fax:928-681-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ73007Medicare PIN