Basic Information
| Provider Information | |||||||||
| NPI: | 1679730493 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BILLY CREEK CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 878 | ||||||||
| Address2: | |||||||||
| City: | SPRINGERVILLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859380878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283335333 | ||||||||
| FaxNumber: | 9283335100 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 W WHITE MOUNTAIN BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKESIDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859297002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283674040 | ||||||||
| FaxNumber: | 9283674042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2008 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | LARUE | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 9283335333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 32794 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.