LONE WOLF MEDICINE INC NPI 1053504225

NPI Information

NPI: 1053504225
Provider Name: LONE WOLF MEDICINE, INC
Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

Address:
806 S PONDEROSA ST
PAYSON, AZ
ZIP 85541
Phone: (928) 474-6617
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LONE WOLF MEDICINE, INC is a medical physician assistant in Payson, AZ. LONE WOLF MEDICINE, INC NPI is 1053504225. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

806 S PONDEROSA ST
PAYSON, AZ
ZIP 85541-541
Phone: (928) 474-6617
Fax: (928) 474-7059

The provider's authorized official is Marilyn F Heron .
The authorized official title is Physician Assisitant and has the following contact phone number (928) 474-6617.

The enumeration date for this NPI number is 8/21/2007 and was last updated on 8/21/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	1454	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2Z0986	OTHER	ARIZONA	HEALTHNET
2	137861	MEDICAID	ARIZONA
3	101247	MEDICARE PIN	ARIZONA
4	R09370	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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