Basic Information
| Provider Information | |||||||||
| NPI: | 1144291915 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SNOWFLAKE MEDICAL CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 S MAIN ST | ||||||||
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| City: | SNOWFLAKE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859375228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285367519 | ||||||||
| FaxNumber: | 9285367305 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SNOWFLAKE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859375228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285367519 | ||||||||
| FaxNumber: | 9285367305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | ZECH | ||||||||
| AuthorizedOfficialFirstName: | MINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | NPI | ||||||||
| AuthorizedOfficialTelephone: | 9285376567 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.