Organization
FEDERAL CORRECTIONAL INSTITUTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICARDO WILLIS ETC (HEALTH SERVICES ADMINISTRATOR)
(623) 465-5163
Entity
Organization
Contact information
Practice address
37900 N 45TH AVE DEPT 1680, PHOENIX, AZ 85086-7008
(623) 465-5797
(623) 465-5116
Mailing address
37900 N 45TH AVE DEPT 1680, PHOENIX, AZ 85086-7008
(623) 465-5797
(623) 465-5116
Taxonomy
Speciality
Code
Description
License number
State
261QP0904X
Federal Public Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/19/2012
Last updated
04/19/2012
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