Country Doctor Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

COUNTRY DOCTOR INC

Practice address

13260 N 94TH Dr Ste 102
Peoria, AZ 85381-4242

Phone

(623) 815-0827

Fax

(623) 875-0325

NPI assigned

Apr 3, 2019

Organization subpart

No

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

Authorized official

Name

Paul Lee Manganelli Sr.

Title

President

Phone

(623) 815-0827

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1821550310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13260 N 94TH DR STE 102",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814242",
            "telephone_number": "623-815-0827",
            "fax_number": "623-875-0325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13260 N 94TH DR STE 102",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814242",
            "telephone_number": "623-815-0827",
            "fax_number": "623-875-0325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY DOCTOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-03",
        "last_updated": "2019-04-11",
        "status": "A",
        "authorized_official_last_name": "MANGANELLI",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "623-815-0827",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Cortesio, RN
• Matthew Corvo, ATC, CSCS
• Stephen C Coty, LPC
• Emily Coulter
• Counseling for the Soul LLC
• Gregory Michael Cowan, M.D.
• Kimberli Sue Cox, MD
• Kelsey Cozzolino, PHARMD
• Levi Ervin Boman Cragun, PSY.D.
• Virginia Crane

• Primary Care Clinic/Center in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Primary Care Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; 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.