Provider Demographics
NPI:1144291915
Name:SNOWFLAKE MEDICAL CENTER, PC
Entity type:Organization
Organization Name:SNOWFLAKE MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NPI
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-6567
Mailing Address - Street 1:590 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5228
Mailing Address - Country:US
Mailing Address - Phone:928-536-7519
Mailing Address - Fax:928-536-7305
Practice Address - Street 1:590 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5228
Practice Address - Country:US
Practice Address - Phone:928-536-7519
Practice Address - Fax:928-536-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WCLDGMedicare ID - Type Unspecified