Provider Demographics
NPI:1932389970
Name:YUMA INFECTIOUS DISEASES CENTER PLC
Entity Type:Organization
Organization Name:YUMA INFECTIOUS DISEASES CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENGIDA
Authorized Official - Middle Name:BEKELE
Authorized Official - Last Name:ALEMU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-314-3201
Mailing Address - Street 1:2281 W 24TH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6154
Mailing Address - Country:US
Mailing Address - Phone:928-314-3201
Mailing Address - Fax:928-314-3202
Practice Address - Street 1:2281 W 24TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6154
Practice Address - Country:US
Practice Address - Phone:928-314-3201
Practice Address - Fax:928-314-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37473207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1710916705OtherPERSONAL UPIN