| Prescott Mile High Primary Care | |
|
1040 Whipple St Suite 209 Prescott AZ 86305-1613 | |
| (928) 776-6400 | |
| (928) 776-6410 |
| Full Name | Prescott Mile High Primary Care |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1040 Whipple St, Prescott, Arizona |
| Authorized Official Name and Position | Dieter W. Krantz (VICE PRESIDENT) |
| Authorized Official Contact | 9287722591 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prescott Mile High Primary Care 3051 N Windsong Dr Prescott Valley AZ 86314-2248 Ph: (928) 772-2500 | Prescott Mile High Primary Care 1040 Whipple St Suite 209 Prescott AZ 86305-1613 Ph: (928) 776-6400 |
| NPI Number | 1275526402 |
|---|---|
| Provider Enumeration Date | 08/23/2005 |
| Last Update Date | 08/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275526402 | NPI | - | NPPES |
| 553653 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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