Organization
SOUTHWEST I.D. & MEDICAL CLINIC, LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALPANA JETLY (MANAGER)
(928) 772-3340
Entity
Organization
Contact information
Practice address
3235 N WINDSONG DR, PRESCOTT VALLEY, AZ 86314-1222
(928) 772-3340
(928) 759-9611
Mailing address
PO BOX 1629, PRESCOTT, AZ 86302-1629
(928) 772-3340
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
29064
AZ
Other
Enumeration date
07/05/2006
Last updated
09/07/2023
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