Organization
INDEPENDENT MEDICAL AND SURGICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY MCCONNELL (BUSINESS ADMINISTRATOR)
(928) 649-2600
Entity
Organization
Contact information
Practice address
401 S CALVARY WAY, SUITE D, COTTONWOOD, AZ 86326-4165
(928) 649-2600
(928) 634-7847
Mailing address
401 S CALVARY WAY, SUITE D, COTTONWOOD, AZ 86326-4165
(928) 649-2600
(928) 634-7847
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
—
—
Other
Enumeration date
08/05/2016
Last updated
10/20/2016
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