Organization
EXCEPTIONAL PHYSICIANS GROUP PRESCOTT HOSPITAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD IVAN COLLINS (CREDENTIALING SPECIALIST)
(972) 740-9335
Entity
Organization
Contact information
Practice address
4822 E STATE ROUTE 69, PRESCOTT, AZ 86301-6885
(972) 740-9335
(469) 807-1208
Mailing address
3514 CEDAR SPRINGS RD, DALLAS, TX 75219-4901
(972) 740-9335
(469) 807-1208
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
—
Other
Enumeration date
10/08/2024
Last updated
02/26/2025
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