Provider Demographics
NPI:1730171539
Name:PHYSICIAN BUSINESS SERVICES LLC
Entity type:Organization
Organization Name:PHYSICIAN BUSINESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:KRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-772-2591
Mailing Address - Street 1:1040 WHIPPLE ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1613
Mailing Address - Country:US
Mailing Address - Phone:928-776-6400
Mailing Address - Fax:928-772-6410
Practice Address - Street 1:1040 WHIPPLE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1613
Practice Address - Country:US
Practice Address - Phone:928-776-6400
Practice Address - Fax:928-772-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207Q00000X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ553653Medicaid
AZ64419Medicare ID - Type Unspecified