NPIMap

Organization Active NPI

Yrmc Physiciancare Internal Medicine

  • Primary Care Clinic/Center
  • Prescott, AZ
National Provider Identifier
1396919387
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
35216 Issued in AZ
Legal business name
YRMC PHYSICIANCARE INTERNAL MEDICINE
Practice address
3120 Clearwater Dr
Prescott, AZ 86305-7131
Phone
(928) 771-3704
NPI assigned
Apr 22, 2008
Last updated
Oct 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Authorized official

Name
Mr. Donald Bolin
Title
Executive Director
Phone
(928) 771-5758

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 35216 AZ Primary
Prison Health Clinic/Center 261QP2400X 35216 AZ

Addresses

Primary practice location

3120 Clearwater Dr
Prescott, AZ 86305-7131

Mailing address

3120 Clearwater Dr
Prescott, AZ 86305-7131
Phone (928) 771-3704

National Provider Directory

National Provider Directory
Tax ID family
Yavapai Regional Medical Center Physician Care LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

NPI Registry JSON

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1396919387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 CLEARWATER DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057131",
            "telephone_number": "928-771-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 CLEARWATER DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057131",
            "telephone_number": "928-771-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YRMC PHYSICIANCARE INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "BOLIN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "928-771-5758",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "35216",
            "primary": true
        },
        {
            "code": "261QP2400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Prison Health",
            "state": "AZ",
            "license": "35216",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.