Provider Demographics
NPI:1902270424
Name:QUAIL RIDGE MEDICAL LLC
Entity Type:Organization
Organization Name:QUAIL RIDGE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:SHAYNE
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP, DC
Authorized Official - Phone:928-529-5086
Mailing Address - Street 1:2331 HUALAPAI MOUNTAIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-6207
Mailing Address - Country:US
Mailing Address - Phone:928-529-5086
Mailing Address - Fax:928-529-5089
Practice Address - Street 1:2331 HUALAPAI MOUNTAIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6207
Practice Address - Country:US
Practice Address - Phone:928-529-5086
Practice Address - Fax:928-529-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty