Provider Demographics
NPI:1043454242
Name:VERDE VALLEY CONNECTION PRIMARY CARE PLC
Entity type:Organization
Organization Name:VERDE VALLEY CONNECTION PRIMARY CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:928-634-2574
Mailing Address - Street 1:8 E COTTONWOOD ST BLDG C
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4382
Mailing Address - Country:US
Mailing Address - Phone:928-203-5400
Mailing Address - Fax:928-634-2841
Practice Address - Street 1:8 E COTTONWOOD ST BLDG C
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4382
Practice Address - Country:US
Practice Address - Phone:928-203-5400
Practice Address - Fax:928-634-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty