Provider Demographics
NPI:1902158108
Name:SEDONA FAMILY HEALTH, PLLC
Entity type:Organization
Organization Name:SEDONA FAMILY HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PASLIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-214-1070
Mailing Address - Street 1:1890 W STATE ROUTE 89A
Mailing Address - Street 2:SUITE D
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5571
Mailing Address - Country:US
Mailing Address - Phone:928-214-1070
Mailing Address - Fax:928-214-1071
Practice Address - Street 1:1890 W STATE ROUTE 89A
Practice Address - Street 2:SUITE D
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5571
Practice Address - Country:US
Practice Address - Phone:928-214-1070
Practice Address - Fax:928-214-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1982737169Medicare PIN