Organization
LITTLE COLORADO EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSS RONAN (EXEC. VICE PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
1501 N WILLIAMSON AVE, WINSLOW, AZ 86047-2735
(928) 289-4691
(928) 289-5691
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
(214) 712-2444
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
832768
—
AZ
01
—
AZ0866770
BLUE SHIELD
AZ
01
—
AZ0912160
BLUE SHIELD
AZ
Enumeration date
08/11/2006
Last updated
04/16/2014
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