Organization
VERSATILE MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN A NICHOLS M.D. (PHYSICIAN/GENERAL MANAGER)
(623) 975-8400
Entity
Organization
Contact information
Practice address
13055 W MCDOWELL RD, SUITE E-106, AVONDALE, AZ 85392-6449
(623) 975-8400
(623) 935-2975
Mailing address
13055 W MCDOWELL RD, SUITE E-106, AVONDALE, AZ 85392-6449
(623) 975-8400
(623) 935-2975
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
AZ26993
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
486581001
—
AZ
05
—
517675
—
AZ
01
—
AZ0761300
BLUE CROSS BLUE SHIELD
AZ
01
—
AZ0765500
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
09/20/2006
Last updated
06/08/2015
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