Basic Information
| Provider Information | |||||||||
| NPI: | 1659513760 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR. JOHN R. MARKHAM PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PRESCOTT VISION & EYE SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1680 WILLOW CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863011108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287783950 | ||||||||
| FaxNumber: | 9287783999 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 W YAVAPAI ST | ||||||||
| Address2: | |||||||||
| City: | WICKENBURG | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853903280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286842880 | ||||||||
| FaxNumber: | 9286843209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2009 | ||||||||
| LastUpdateDate: | 04/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9287783950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 4498 | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 2Z6546 | 01 | AZ | HEALTH NET | OTHER | NNP12599 | 01 | AZ | UNIVERSAL HEALTH CARE | OTHER | 033176-001 | 01 | AZ | MERCYCARE | OTHER | 190721 | 01 | AZ | AHCCCS | OTHER | 190721 | 05 | AZ | MEDICAID | 3421045 | 01 | AZ | CIGNA | OTHER | 572818 | 01 | AZ | RAN-AMN | OTHER | AZ01170 | 01 | AZ | MEDICARE SUBMITTER ID | OTHER | 7742967 | 01 | AZ | AETNA | OTHER | 866291-9714 | 01 | AZ | HUMANA | OTHER |