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3180 E 40th St # 1-45a5g Yuma AZ 85365-7772 | |
| (480) 983-0065 | |
| (480) 288-5339 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3180 E 40th St # 1-45a5g, Yuma, Arizona |
| Authorized Official Name and Position | Norman E. Mudd (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4809830065 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
625 N. Plaza Drive Apache Junction AZ 85120-5501 Ph: (480) 983-0065 | 3180 E 40th St # 1-45a5g Yuma AZ 85365-7772 Ph: (480) 983-0065 |
| NPI Number | 1396168902 |
|---|---|
| Provider Enumeration Date | 02/03/2014 |
| Last Update Date | 10/14/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396168902 | NPI | - | NPPES |
| MED 5473 | Other | AZ | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MED 5473 (Arizona) | Primary |
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