Organization
YRMC PHYSICIANCARE INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD BOLIN (EXECUTIVE DIRECTOR)
(928) 771-5758
Entity
Organization
Contact information
Practice address
3120 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 771-3704
Mailing address
3120 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 771-3704
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
35216
AZ
261QP2400X
Prison Health Clinic/Center
35216
AZ
Other
Enumeration date
04/22/2008
Last updated
10/05/2010
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