Sedona Integrative Medical Clinic, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SEDONA INTEGRATIVE MEDICAL CLINIC, LLC

Practice address

450 S Willard St Ste 101
Cottonwood, AZ 86326-6744

Phone

(928) 284-0166

Fax

(928) 284-1810

NPI assigned

Mar 5, 2009

Last updated

Jul 18, 2022By 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

Nicol Marie Moody

Title

Office Manager

Phone

(928) 284-0166

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 4

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.

• Mary Howland Derose, DC

  • Chiropractor
  • Sedona, AZ
  • NPI 1407991276
  Medicare reassignment Care Compare group NPD
• Eric Alexander Haggard, P.T.

  • Physical Therapist
  • Cottonwood, AZ
  • NPI 1568507358
  Medicare reassignment Care Compare group NPD
• Linda M Haggard, PAC

  • Medical Physician Assistant
  • Cottonwood, AZ
  • NPI 1871508655
  Medicare reassignment Care Compare group
• Lisa Coffey Oliver, M.D.

  • Neuromusculoskeletal Medicine & OMM Physician
  • Cottonwood, AZ
  • NPI 1326253444
  NPD (past)

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

{
    "created_epoch": "1236211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1932349867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S WILLARD ST STE 101",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863266744",
            "telephone_number": "928-284-0166",
            "fax_number": "928-284-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S WILLARD ST STE 101",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863266744",
            "telephone_number": "928-284-0166",
            "fax_number": "928-284-1810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEDONA INTEGRATIVE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-05",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "NICOL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "928-284-0166"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "5669",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John S. Schor, M.D.
• Kimberly Scott-Freeman, RDH
• Andrea C Scott, PHD
• Melissa L Scott, APRN
• Sedona Foot & Ankle Specialists P C
• Sedona Regenerative Medicine, PC
• Michael J Seip, D.D.S.
• Senska Physical Therapy, Inc
• Joseph J Sentivanac Jr., R.PH.
• Richard D Sepela, CRNA

• Family Medicine Physician in Cottonwood, AZ
• Providers in Cottonwood, 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 Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.