Asura Healthcare LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41469 Issued in AZ

Legal business name

ASURA HEALTHCARE LLC

Practice address

12075 E State Route 69 Ste B
Dewey, AZ 86327-4517

Phone

(405) 590-8861

Fax

(888) 389-7077

NPI assigned

Sep 13, 2017

Last updated

Sep 13, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John S Gilliam, MDNPI 1003877085

Title

Medical Director

Phone

(405) 590-8861

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John S. Gilliam, MD

  • Family Medicine Physician
  • Mayer, AZ
  • NPI 1003877085
  NPD (past) Authorized official

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505260800000",
    "number": "1669991485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E GURLEY ST UNIT 479",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863013804",
            "telephone_number": "405-590-8861",
            "fax_number": "888-389-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12075 E STATE ROUTE 69 STE B",
            "city": "DEWEY",
            "state": "AZ",
            "postal_code": "863274517",
            "telephone_number": "405-590-8861",
            "fax_number": "888-389-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASURA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-13",
        "last_updated": "2017-09-13",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "405-590-8861",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "AZ",
            "license": "AP3224",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "41469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Logan Baxter, DC
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• Cynthia Darlene Boutin, CSLPA

• Family Medicine Physician in Dewey, AZ
• Providers in Dewey, 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 Sep 13, 2017; 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.