BILLY CREEK CLINIC NPI 1679730493

NPI Information

BILLY CREEK CLINIC is a primary care clinic center in Lakeside, AZ. BILLY CREEK CLINIC NPI is 1679730493. The provider is registered as an organization entity type.

The provider's business location address is:

43 W WHITE MOUNTAIN BLVD
LAKESIDE, AZ
ZIP 85929-002
Phone: (928) 367-4040
Fax: (928) 367-4042

The provider's authorized official is Jennifer L Larue .
The authorized official title is Billing and has the following contact phone number (928) 333-5333.

The CLIA number assigned to this NPI record is 03D2012303 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/20/2008 and was last updated on 5/27/2008.

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:

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