Provider Demographics
NPI:1811872153
Name:RED TAIL HAWK RANCH PLLC
Entity type:Organization
Organization Name:RED TAIL HAWK RANCH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHEEHY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-274-8220
Mailing Address - Street 1:3462 E LAWMAN DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-6591
Mailing Address - Country:US
Mailing Address - Phone:702-274-8220
Mailing Address - Fax:928-251-8079
Practice Address - Street 1:3462 E LAWMAN DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6591
Practice Address - Country:US
Practice Address - Phone:702-274-8220
Practice Address - Fax:928-251-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty