# ANTHRACITE MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366206500
- **Authorized official:** JOSEPH LEONARD VICCICA (MEMBER)
- **Authorized official phone:** (570) 299-0037

## Contact information

- **Practice address:** 4855 BUTTERFLY DR, PRESCOTT, AZ 86301-5770
- **Practice address phone:** (570) 299-0037
- **Mailing address:** 4855 BUTTERFLY DR, PRESCOTT, AZ 86301-5770
- **Mailing address phone:** (570) 299-0037

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/08/2024
- **Last updated:** 02/12/2024