LIFETIME MEDICAL CARE PLLC NPI 1265840037

NPI Information

NPI: 1265840037
Provider Name: LIFETIME MEDICAL CARE PLLC
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 03D2084894

Address:
3101 CLEARWATER DR
SUITE B
PRESCOTT, AZ
ZIP 86305
Phone: (928) 237-9014
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LIFETIME MEDICAL CARE PLLC is a rural health clinic center in Prescott, AZ. LIFETIME MEDICAL CARE PLLC NPI is 1265840037. The provider is registered as an organization entity type.

The provider's business location address is:

3101 CLEARWATER DR
SUITE B
PRESCOTT, AZ
ZIP 86305-180
Phone: (928) 237-9014
Fax: (928) 237-9063

The provider's authorized official is Shelly Damschroder .
The authorized official title is Manager/owner/provider and has the following contact phone number (928) 237-9014.

The CLIA number assigned to this NPI record is 03D2084894 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/24/2014 and was last updated on 1/4/2015.

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	261QR1300X	Clinic/Center	Rural Health	AP7289	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	AP7289	OTHER	ARIZONA	NURSE PRACTITIONER LICENSE NUMBER

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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