Basic Information
Provider Information
NPI: 1861899619
EntityType: 2
ReplacementNPI:  
OrganizationName: GOLD CANYON URGENT CARE AND FAMILY MEDICINE
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Mailing Information
Address1: 6820 S KINGS RANCH RD
Address2: SUITE 130
City: GOLD CANYON
State: AZ
PostalCode: 851182935
CountryCode: US
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Practice Location
Address1: 6820 S KINGS RANCH RD
Address2: SUITE 130
City: GOLD CANYON
State: AZ
PostalCode: 851182935
CountryCode: US
TelephoneNumber: 4809823691
FaxNumber: 4809823692
Other Information
ProviderEnumerationDate: 11/21/2014
LastUpdateDate: 11/21/2014
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AuthorizedOfficialLastName: RUTKOWSKI
AuthorizedOfficialFirstName: DAITON
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AuthorizedOfficialTitleorPosition: CEO MANAGING PARTNER
AuthorizedOfficialTelephone: 4809823691
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IsOrganizationSubpart: N
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AuthorizedOfficialNamePrefix: MR.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X5940AZY193400000X SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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