# ASURA HEALTHCARE LLC

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

## Provider details

- **NPI number:** 1669991485
- **Authorized official:** DR. JOHN S GILLIAM MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (405) 590-8861

## Contact information

- **Practice address:** 12075 E STATE ROUTE 69 STE B, DEWEY, AZ 86327-4517
- **Practice address phone:** (405) 590-8861
- **Practice address fax:** (888) 389-7077
- **Mailing address:** 303 E GURLEY ST UNIT 479, PRESCOTT, AZ 86301-3804
- **Mailing address phone:** (405) 590-8861
- **Mailing address fax:** (888) 389-7077

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 41469 | AZ | Yes |
| 261QM0850X | Adult Mental Health Clinic/Center | AP3224 | AZ | — |

## Other

- **Enumeration date:** 09/13/2017
- **Last updated:** 09/13/2017