Organization
WICKENBURG HEALTHCARE ALLIANCE INC
Active
Other names
WHA Medical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS A MATLOCK MD (PRESIDENT)
(928) 684-7255
Entity
Organization
Contact information
Practice address
108 N FRONTIER ST, WICKENBURG, AZ 85390-4411
(928) 684-7255
Mailing address
108 N FRONTIER STREET, WICKENBURG, AZ 85390-4411
(928) 684-7255
(623) 691-8113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AZ4277
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203878
—
AZ
Enumeration date
12/12/2011
Last updated
01/30/2012
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