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6152 Hardscrabble Road Pine AZ 85544 | |
(928) 476-3258 | |
(928) 476-3186 |
Full Name | |
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Speciality | Family Medicine |
Location | 6152 Hardscrabble Road, Pine, Arizona |
Authorized Official Name and Position | Lisa Marie York (PHYSICIAN) |
Authorized Official Contact | 9284763258 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 409 Pine AZ 85544-0409 Ph: (928) 476-3258 | 6152 Hardscrabble Road Pine AZ 85544 Ph: (928) 476-3258 |
NPI Number | 1710170642 |
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Provider Enumeration Date | 08/23/2007 |
Last Update Date | 01/17/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710170642 | NPI | - | NPPES |
391186 | Medicaid | AZ | |
AZ0740060 | Other | AZ | BLUE CROSS BLUE SHIELD |
1Z9017 | Other | AZ | HEALTHNET |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 24012 (Arizona) | Primary |