Provider Demographics
NPI:1912984329
Name:SILVERCREEK FAMILY WALKIN CLINIC, LLC
Entity Type:Organization
Organization Name:SILVERCREEK FAMILY WALKIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:928-536-4322
Mailing Address - Street 1:PO BOX 1249
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-1249
Mailing Address - Country:US
Mailing Address - Phone:928-536-4322
Mailing Address - Fax:
Practice Address - Street 1:815 N MAIN ST
Practice Address - Street 2:#D
Practice Address - City:TAYLOR
Practice Address - State:AZ
Practice Address - Zip Code:85939-1249
Practice Address - Country:US
Practice Address - Phone:928-536-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68692Medicare PIN