PRESCOTT RENAL CARE GROUP, LLC (NPI# 1386756195) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386756195 |
| Entity Type | Organization |
| Organization Name | PRESCOTT RENAL CARE GROUP, LLC |
| Other Organization Name | RENAL CARE GROUP PRESCOTT |
| Practice Address |
13175 E Highway 169 Dewey AZ 86327-7372 |
| Practice Telephone | 9287135122 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MARK FAWCETT (TREASURER) |
| Authorized Official Telephone | 7814029000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| RENAL CARE GROUP PRESCOTT | Doing Business As Name - Organization |
| Street Address |
13175 E HIGHWAY 169 |
| City | DEWEY |
| State | AZ |
| Zip Code | 86327-7372 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649223306 | Mikrut Physical Therapy LLC | Clinic/Center | 13175 E Highway 169, Dewey, AZ 86327-7372 | 2006-05-17 |
| 1508060930 | Candace Oen | Physician Assistant | 13175 E Highway 169, Dewey, AZ 86327-7372 | 2007-06-11 |
| 1134243157 | Hospice of Phoenix LLC | Hospice Care, Community Based | 13175 E Highway 169, Dewey, AZ 86327-7372 | 2007-03-16 |
| 1013009091 | Richard L D'armand | Physician Assistant | 13175 E Highway 169, Dewey, AZ 86327-7372 | 2006-09-28 |
| 1346293248 | James Mikrut | Physical Therapist | 13175 E Highway 169, Dewey, AZ 86327-7372 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043791577 | Sarabeth Zurbano Roberto | Nurse Practitioner | 12075 Arizona 69, Dewey, AZ 86327 | 2018-08-23 |
| 1194224493 | Danielle Barbaro | Nurse Practitioner | 12075 Az - 69, Dewey, AZ 86327 | 2018-02-02 |
| 1437669504 | Caroline Bingham | Registered Nurse | 12075 Az State Route 69, Dewey, AZ 86327 | 2017-10-03 |
| 1245778323 | Copper Basin Healthcare, Inc. | Hospice Care, Community Based | 13207 E State Route 169 Ste A, Dewey, AZ 86327 | 2017-02-08 |
| 1346790748 | Holly Engelman | Nurse Practitioner | 150 Az-69 #1a, Dewey, AZ 86327 | 2016-10-10 |
| 1902262272 | Bradshaw Mountain Family Medicine LLC | Nurse Practitioner | 1163 E Old Chisholm Trail Suite C, Dewey, AZ 86327 | 2016-01-02 |
| 1255703229 | Clarence & Jeanne Kinsley, Dba | Respite Care | 17100 E. Lions Crossing Rd, Dewey, AZ 86327 | 2015-10-29 |
| 1003060534 | Sequelcare of Arizona, LLC | Community Based Residential Treatment Facility, Mental Illness | 14410 E. Blue Ridge Road, Dewey, AZ 86327 | 2008-11-11 |
| 1740431196 | Andrew Gregory Bowers | Speech-Language Pathologist | 422 N. La Paz St., Dewey, AZ 86327 | 2008-10-03 |
| 1114090925 | Mingus Mountain Estate Residential Center Inc | Assisted Living Facility | 100 Dewey Road, Farrington Home, Dewey, AZ 86327 | 2006-11-17 |
| Find all providers in zip 86327 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
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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.