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101 Taylor Street Patagonia AZ 85624-0645 | |
| (520) 394-2262 | |
| (520) 394-2753 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 Taylor Street, Patagonia, Arizona |
| Authorized Official Name and Position | Daniel Prevost (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5207612128 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
825 N Grand Ave Ste 100 Nogales AZ 85621-2385 Ph: (520) 761-2128 | 101 Taylor Street Patagonia AZ 85624-0645 Ph: (520) 394-2262 |
| NPI Number | 1003837618 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 01/11/2023 |
| Certification Date | 01/11/2023 |
| Medicare PECOS PAC ID | 8123926326 |
|---|---|
| Medicare Enrollment ID | O20100617000415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003837618 | NPI | - | NPPES |
| 031809 | Other | AZ | MEDICARE PART A GROUP # |
| ZFQ31809 | Other | AZ | MEDICARE PART B GROUP # |