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PONDEROSA FAMILY CARE LLC NPI 1144535626


NPI Information

NPI: 1144535626
Provider Name: PONDEROSA FAMILY CARE, LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 03D2187216

Address:
806 S PONDEROSA ST
PAYSON, AZ
ZIP 85541
Phone: (928) 468-8603
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PONDEROSA FAMILY CARE, LLC is an internal medicine in Payson, AZ. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. PONDEROSA FAMILY CARE, LLC NPI is 1144535626. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

806 S PONDEROSA ST
PAYSON, AZ
ZIP 85541-541
Phone: (928) 468-8603

The provider's authorized official is Alan P Michels .
The authorized official title is Physician and has the following contact phone number (928) 468-8603.

The CLIA number assigned to this NPI record is 03D2187216 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/9/2010 and was last updated on 12/5/2014.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics29337ARIZONANo
2207R00000XInternal Medicine29337ARIZONAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Z74003MEDICARE PINARIZONA
2H42890MEDICARE UPINARIZONA
3703422MEDICAIDARIZONA

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.