Provider Demographics
NPI:1487145835
Name:BYRD FAMILY MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:BYRD FAMILY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:FMP
Authorized Official - Phone:928-457-2019
Mailing Address - Street 1:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-1295
Mailing Address - Country:US
Mailing Address - Phone:928-243-8377
Mailing Address - Fax:
Practice Address - Street 1:14 E TUMBLEWEED LN
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:AZ
Practice Address - Zip Code:85939
Practice Address - Country:US
Practice Address - Phone:928-457-2019
Practice Address - Fax:833-944-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3061261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center