Basic Information
| Provider Information | |||||||||
| NPI: | 1083932784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTHCARE OF DOUGLAS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2174 WEST OAK AVENUE | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208055943 | ||||||||
| FaxNumber: | 5203642551 | ||||||||
| Practice Location | |||||||||
| Address1: | 2174 W OAK AVE | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856076003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208055943 | ||||||||
| FaxNumber: | 5203642551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2010 | ||||||||
| LastUpdateDate: | 05/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | BERRY | ||||||||
| AuthorizedOfficialFirstName: | ROBERTA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 5208055943 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | H-0015 | AZ | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.