| My Buoyant Health | |
|
509 W Diana Ave Phoenix AZ 85021-4534 | |
| (602) 503-2832 | |
| Not Available |
| Full Name | My Buoyant Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 509 W Diana Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Russell Horning (OWNER) |
| Authorized Official Contact | 6025032832 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Buoyant Health 509 W Diana Ave Phoenix AZ 85021-4534 Ph: (602) 503-2832 | My Buoyant Health 509 W Diana Ave Phoenix AZ 85021-4534 Ph: (602) 503-2832 |
| NPI Number | 1861190225 |
|---|---|
| Provider Enumeration Date | 02/15/2023 |
| Last Update Date | 08/26/2023 |
| Certification Date | 08/26/2023 |
| Medicare PECOS PAC ID | 5193184505 |
|---|---|
| Medicare Enrollment ID | O20230703001884 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861190225 | NPI | - | NPPES |
| Provider Name | Russell A Horning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669526158 PECOS PAC ID: 8123911237 Enrollment ID: I20040203001033 |
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