| Alta Medical Clinic Inc Of Arizona | |
|
4742 N 24th St Ste 300 Phoenix AZ 85016-9107 | |
| (909) 236-0338 | |
| Not Available |
| Full Name | Alta Medical Clinic Inc Of Arizona |
|---|---|
| Speciality | General Practice |
| Location | 4742 N 24th St Ste 300, Phoenix, Arizona |
| Authorized Official Name and Position | Peterson Go (PRESIDENT) |
| Authorized Official Contact | 9092360338 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alta Medical Clinic Inc Of Arizona 4742 N 24th St Ste 300 Phoenix AZ 85016-9107 Ph: (909) 236-0338 | Alta Medical Clinic Inc Of Arizona 4742 N 24th St Ste 300 Phoenix AZ 85016-9107 Ph: (909) 236-0338 |
| NPI Number | 1679280671 |
|---|---|
| Provider Enumeration Date | 10/31/2022 |
| Last Update Date | 10/31/2022 |
| Certification Date | 10/31/2022 |
| Medicare PECOS PAC ID | 2163891516 |
|---|---|
| Medicare Enrollment ID | O20221207002386 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679280671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Eric Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851557813 PECOS PAC ID: 7618016619 Enrollment ID: I20201203002855 |
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