NPIMap

Organization Active NPI

Prescott Family Medicine PLLC

  • Family Medicine Physician
  • Prescott, AZ
National Provider Identifier
1720070303
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRESCOTT FAMILY MEDICINE PLLC
Practice address
726 Gail Gardner Way
Suite B
Prescott, AZ 86305-2314
Phone
(928) 445-4100
Fax
(928) 445-9132
NPI assigned
Aug 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kevin S Doyle, MDNPI 1114912961
Title
Medical Doctor
Phone
(928) 445-4100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X AZ Primary

Addresses

Primary practice location

726 Gail Gardner Way
Suite B
Prescott, AZ 86305-2314

Mailing address

726 Gail Gardner Way
Suite B
Prescott, AZ 86305-2314
Phone (928) 445-4100

Other identifiers 1

IdentifierTypeStateIssuer
107085OtherAETNA

National Provider Directory

National Provider Directory

Locations

726 Gail Gardner Way
Ste B
Prescott, AZ 86305
Phone (520) 455-4100

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720070303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 GAIL GARDNER WAY",
            "address_2": "SUITE B",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863052314",
            "telephone_number": "928-445-4100",
            "fax_number": "928-445-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "726 GAIL GARDNER WAY",
            "address_2": "SUITE B",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863052314",
            "telephone_number": "928-445-4100",
            "fax_number": "928-445-9132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOYLE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "928-445-4100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "107085",
            "state": null
        }
    ],
    "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 Aug 22, 2020; 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.