Provider Demographics
NPI:1700185436
Name:KACHINA MEDICAL CENTER LTD
Entity type:Organization
Organization Name:KACHINA MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-947-7784
Mailing Address - Street 1:7700 E INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4043
Mailing Address - Country:US
Mailing Address - Phone:480-947-7784
Mailing Address - Fax:480-945-8395
Practice Address - Street 1:7700 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4043
Practice Address - Country:US
Practice Address - Phone:480-947-7784
Practice Address - Fax:480-945-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ144093Medicare PIN