| |
3272 E Rio Virgin Road Littlefield AZ 86432-3200 | |
(928) 347-5971 | |
(928) 347-5793 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3272 E Rio Virgin Road, Littlefield, Arizona |
Authorized Official Name and Position | Christopher J Hansen (CEO) |
Authorized Official Contact | 9286459675 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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P O Box 1625 827 Vista Avenue Page AZ 86040-1625 Ph: (928) 645-9675 | 3272 E Rio Virgin Road Littlefield AZ 86432-3200 Ph: (928) 347-5971 |
NPI Number | 1780653741 |
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Provider Enumeration Date | 03/14/2006 |
Last Update Date | 09/23/2021 |
Medicare PECOS PAC ID | 4082509591 |
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Medicare Enrollment ID | O20090226000140 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780653741 | NPI | - | NPPES |
100509882 | Medicaid | NV | |
594011 | Medicaid | AZ | |
432857 | Medicaid | AZ |