Prescott Medical Executive Detox

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

3273 Issued in AZ

Legal business name

PRESCOTT MEDICAL EXECUTIVE DETOX

Practice address

134 S Granite St
Prescott, AZ 86303-4710

Phone

(928) 227-2300

Fax

(928) 445-1416

NPI assigned

May 9, 2011

Organization subpart

No

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

Authorized official

Name

Patrick Gallus, D.O.

Title

Chief Administrator

Phone

(928) 899-0128

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1304899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304899200000",
    "number": "1982996989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 S GRANITE ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863034710",
            "telephone_number": "928-227-2300",
            "fax_number": "928-445-1416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 S GRANITE ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863034710",
            "telephone_number": "928-227-2300",
            "fax_number": "928-445-1416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT MEDICAL EXECUTIVE DETOX",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-09",
        "last_updated": "2011-05-09",
        "status": "A",
        "authorized_official_last_name": "GALLUS",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATOR",
        "authorized_official_telephone_number": "928-899-0128",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "3273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prescott House Inc
• Prescott House Treatment LLC
• Prescott Interventional Radiology LLC
• Prescott Lung Physicians LTD
• Prescott Medical and Dermatology Group
• Prescott Medical Imaging, LLC
• Prescott Medical Investment LLC
• Prescott Mobililty Store Inc
• Prescott Nursing and Rehabilitation Center LLC
• Prescott Osteoporosis Testing Center

• Substance Abuse Rehabilitation Facility in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; 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.