ARIZONA GRAND MEDICAL CENTER PLLC (NPI# 1003111378) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003111378 |
| Entity Type | Organization |
| Organization Name | ARIZONA GRAND MEDICAL CENTER PLLC |
| Other Organization Name | AGMC - CROSSINGS |
| Practice Address |
3777 Crossings Dr Prescott AZ 86305-7121 |
| Mailing Address |
Po Box 47729 Phoenix AZ 85068-7729 |
| Practice Telephone | 9287719693 |
| Practice Fax Number | 9287080505 |
| Mailing Telephone | 6239345600 |
| Mailing Fax Number | 6239345603 |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2014-01-06 |
| Authorized Official Name | MRS. SATTY K BHOWRA (ADMINISTRATOR) |
| Authorized Official Telephone | 6025504065 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| AGMC - Crossings | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427224443 | Arizona Grand Medical Center Pllc | Clinic/Center | 7900 E Florentine Rd, Prescott Valley, AZ 86314-2218 | 2008-04-30 |
| 1720497258 | Arizona Grand Medical Center Pllc | Clinic/Center | 3773 Crossings Dr, Suite B, Prescott, AZ 86305-7140 | 2014-08-08 |
| 1619998705 | Arizona Grand Medical Center Pllc | Clinic/Center | 3777 Crossings Dr, Prescott, AZ 86305-7121 | 2006-07-22 |
| 1992751952 | Arizona Grand Medical Center Pllc | Clinic/Center | 4225 W Glendale Ave, Suite B 200, Phoenix, AZ 85051-8194 | 2006-05-25 |
| Street Address |
3777 CROSSINGS DR |
| City | PRESCOTT |
| State | AZ |
| Zip Code | 86305-7121 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679575054 | Ketan Jani | Internal Medicine | 3777 Crossings Dr, Prescott, AZ 86305-7121 | 2005-08-15 |
| 1184829061 | Mohammad-ali El-harakeh | Internal Medicine | 3777 Crossings Dr, Prescott, AZ 86305-7121 | 2007-06-19 |
| 1619998705 | Arizona Grand Medical Center Pllc | Clinic/Center | 3777 Crossings Dr, Prescott, AZ 86305-7121 | 2006-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972005395 | Granite View Adult Care Home LLC | Assisted Living Facility | 7105 Williamson Valley Road, Prescott, AZ 86305 | 2018-03-01 |
| 1215468095 | Valerie Williams | Occupational Therapist | 926 S. Hinman Dr., Prescott, AZ 86305 | 2017-03-23 |
| 1174073837 | Caspian Gleam Medical Center LLC | Clinic/Center | 3130 Stillwater Drive, Suite B, Prescott, AZ 86305 | 2016-10-06 |
| 1114388634 | Marla Beth Perkins | Speech-Language Pathologist | 3160 Stillwater Dr., Prescott, AZ 86305 | 2016-03-10 |
| 1790159853 | Michele A. Bibeau, D.d.s. | Dentist | 1058 Fair Street, Suite A, Prescott, AZ 86305 | 2015-11-30 |
| 1609264837 | Integrative Pain Centres of Prescott | Pain Medicine | 3769 Crossings Drive, Suite B, Integrative Pain Centres of Prescott, Prescott, AZ 86305 | 2014-12-22 |
| 1649697251 | Sharon Marilyn Jackson | Counselor | 3636 Crossings Drive, Prescott, AZ 86305 | 2014-03-20 |
| 1215351259 | Stefanie Maneval | Registered Nurse | 900 Iron Springs Rd, Prescott, AZ 86305 | 2014-02-11 |
| 1508207523 | Recovery In The Pines, LLC | Community/Behavioral Health | 919 12th Place #13, Prescott, AZ 86305 | 2013-07-08 |
| 1871857359 | Neal Herbert Segovia Cabaluna | Internal Medicine | 3773 Crossings Dr Ste C, Prescott, AZ 86305 | 2012-06-28 |
| Find all providers in zip 86305 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174073837 | Caspian Gleam Medical Center LLC | Clinic/Center | 3130 Stillwater Drive, Suite B, Prescott, AZ 86305 | 2016-10-06 |
| 1720497258 | Arizona Grand Medical Center Pllc | Clinic/Center | 3773 Crossings Dr, Suite B, Prescott, AZ 86305-7140 | 2014-08-08 |
| 1619998705 | Arizona Grand Medical Center Pllc | Clinic/Center | 3777 Crossings Dr, Prescott, AZ 86305-7121 | 2006-07-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.