Wickenburg Healthcare Alliance Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

AZ4277 Issued in AZ

Legal business name

WICKENBURG HEALTHCARE ALLIANCE INC

Practice address

108 N Frontier St
Wickenburg, AZ 85390-4411

Phone

(928) 684-7255

NPI assigned

Dec 12, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas A Matlock, MD

Title

President

Phone

(928) 684-7255

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• WHA Medical Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1063780583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N FRONTIER STREET",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853904411",
            "telephone_number": "928-684-7255",
            "fax_number": "623-691-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 N FRONTIER ST",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853904411",
            "telephone_number": "928-684-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKENBURG HEALTHCARE ALLIANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-12",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "MATLOCK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-684-7255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "AZ4277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203878",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WHA Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mitchell Wagner, MD
• Rebecca Suzanne Walpole, FNP
• Christoper Alan Warren, NRP, FP-C, CCP-C
• Conor Westerman, PMHNP
• Wickenburg Diabetes & Wound Care Center LLC
• Wickenburg Home Care
• Wickenburg Hospital Pharmacy
• Wickenburg Unified School District #9
• Rachel Willis
• Cheryl Wolfe-Ruiz, P.A.-C

• Family Medicine Physician in Wickenburg, AZ
• Providers in Wickenburg, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.