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Organization
FAMILY HEALTH CENTER OF SIERRA VISTA, PC
Active
Organization
FAMILY HEALTH CENTER OF SIERRA VISTA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH E MAYBERRY MD (PRESIDENT)
(520) 459-3116
Entity
Organization
Contact information
Practice address
1800 E WILCOX DR, SIERRA VISTA, AZ 85635-2756
(520) 459-3116
(520) 459-7397
Mailing address
1800 E WILCOX DR, SIERRA VISTA, AZ 85635-2756
(520) 459-3116
(520) 459-7397
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16890
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A002
TRICARE WPS
AZ
01
—
CH7902
RAILROAD MEDICARE
AZ
01
—
HEALTHNET
1Z4100
AZ
Enumeration date
06/04/2007
Last updated
12/11/2018
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