| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 906 Mather Dr, Bear, Delaware |
| Authorized Official Name and Position | Aloys Chiafie Tenkiang (NURE PRACTITIONER) |
| Authorized Official Contact | 3027501979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
906 Mather Dr Bear DE 19701-4941 Ph: (302) 750-1979 | 906 Mather Dr Bear DE 19701-4941 Ph: (302) 750-1979 |
| NPI Number | 1326816182 |
|---|---|
| Provider Enumeration Date | 12/12/2023 |
| Last Update Date | 11/21/2024 |
| Certification Date | 11/21/2024 |
| Medicare PECOS PAC ID | 5294188710 |
|---|---|
| Medicare Enrollment ID | O20240131001869 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326816182 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Aloys Chiafie Tenkiang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689384406 PECOS PAC ID: 5698148328 Enrollment ID: I20230228002524 |
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