Organization
ASURA HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN S GILLIAM MD (MEDICAL DIRECTOR)
(405) 590-8861
Entity
Organization
Contact information
Practice address
12075 E STATE ROUTE 69 STE B, DEWEY, AZ 86327-4517
(405) 590-8861
(888) 389-7077
Mailing address
303 E GURLEY ST UNIT 479, PRESCOTT, AZ 86301-3804
(405) 590-8861
(888) 389-7077
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41469
AZ
261QM0850X
Adult Mental Health Clinic/Center
AP3224
AZ
Other
Enumeration date
09/13/2017
Last updated
09/13/2017
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