Provider Demographics
NPI:1104090737
Name:JOHN R. MARKHAM PC
Entity type:Organization
Organization Name:JOHN R. MARKHAM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-778-3950
Mailing Address - Street 1:1680 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-778-3950
Mailing Address - Fax:928-778-3999
Practice Address - Street 1:399 PALOMINO ROAD
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323
Practice Address - Country:US
Practice Address - Phone:928-636-5504
Practice Address - Fax:928-636-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033176Medicaid
15220OtherAVESIS
0384690001OtherDMERC OPTICAL SUPPLIER - PRESCOTT
AZ01170OtherMEDICARE SUBMITTER ID - PRESCOTT
5858351OtherAETNA
AZ190721Medicaid
866291-9714OtherHUMANA
AZ190721Medicaid
15220OtherAVESIS
Z63118Medicare PIN