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Contact Information

CHARLES H. TADLOCK, M.D. LTD.
1912 MIAMI AVE
KINGMAN, AZ86401-4127
 Phone: 702-474-0200
 Fax: 702-946-5328
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

207LP2900X 05 Physician/Anesthesiology
 

Family

363LF0000X 50 Nurse Practitioner
 

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for CHARLES H. TADLOCK, M.D. LTD.

NPI Number 1548422876
LBN Legal business name CHARLES H. TADLOCK, M.D. LTD.
Authorized official TAMMY SHAFFER - (ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 06/27/2008
Last updated 02/18/2014 - About 12 years ago
Identifiers
AZ License # 26067
AZ License # 4873
AZ License # AP4247
AZ Medicaid 069618
AZ Other 35714 MEDICARE INDIVIDUAL PIN (TADLOCK)
AZ Other Z146133 MEDICARE PIN GERALD JONES, PA-C
AZ Other Z149395 MEDICARE PIN JULIE BROWN, FNP
AZ Other 720000127 RR MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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