# WICKENBURG HEALTHCARE ALLIANCE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WHA Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063780583
- **Authorized official:** DR. THOMAS A MATLOCK MD (PRESIDENT)
- **Authorized official phone:** (928) 684-7255

## Contact information

- **Practice address:** 108 N FRONTIER ST, WICKENBURG, AZ 85390-4411
- **Practice address phone:** (928) 684-7255
- **Mailing address:** 108 N FRONTIER STREET, WICKENBURG, AZ 85390-4411
- **Mailing address phone:** (928) 684-7255
- **Mailing address fax:** (623) 691-8113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | AZ4277 | AZ | Yes |

## Other

- **Enumeration date:** 12/12/2011
- **Last updated:** 01/30/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 203878 | — | AZ |