| Eclipse Psychiatry | |
|
2152 S Vineyard Unit 113-114 Mesa AZ 85210-6871 | |
| (623) 282-2047 | |
| Not Available |
| Full Name | Eclipse Psychiatry |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2152 S Vineyard Unit 113-114, Mesa, Arizona |
| Authorized Official Name and Position | Anthony Kimani (PRESIDENT) |
| Authorized Official Contact | 9786970301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eclipse Psychiatry 2152 S Vineyard Mesa AZ 85210-6871 Ph: (978) 697-0301 | Eclipse Psychiatry 2152 S Vineyard Unit 113-114 Mesa AZ 85210-6871 Ph: (623) 282-2047 |
| NPI Number | 1043888688 |
|---|---|
| Provider Enumeration Date | 06/10/2021 |
| Last Update Date | 05/24/2022 |
| Certification Date | 05/24/2022 |
| Medicare PECOS PAC ID | 9335537992 |
|---|---|
| Medicare Enrollment ID | O20211101001625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043888688 | NPI | - | NPPES |
| 1295370401 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Anthony Kimani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295370401 PECOS PAC ID: 2365877842 Enrollment ID: I20200123001343 |
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