Organization
PINETOP PRIMARY PALLIATIVE CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE MCCORMICK NP (OWNER)
(928) 367-1077
Entity
Organization
Contact information
Practice address
300 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929-7014
(928) 367-1077
Mailing address
PO BOX 888, LAKESIDE, AZ 85929-0888
(928) 367-1077
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300123
—
AZ
Enumeration date
04/20/2021
Last updated
04/20/2021
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