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3654 W Anthem Way Ste B106 Anthem AZ 85086-0455 | |
| (602) 848-3906 | |
| (602) 848-3454 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3654 W Anthem Way Ste B106, Anthem, Arizona |
| Authorized Official Name and Position | Paula Rauschkolb (OWNER) |
| Authorized Official Contact | 6028483906 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3654 W Anthem Way Ste B106 Anthem AZ 85086-0455 Ph: (602) 848-3906 | 3654 W Anthem Way Ste B106 Anthem AZ 85086-0455 Ph: (602) 848-3906 |
| NPI Number | 1215664156 |
|---|---|
| Provider Enumeration Date | 08/02/2022 |
| Last Update Date | 01/24/2023 |
| Certification Date | 01/24/2023 |
| Medicare PECOS PAC ID | 8426434499 |
|---|---|
| Medicare Enrollment ID | O20220928000808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215664156 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Paula K Rauschkolb |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396963914 PECOS PAC ID: 6103075908 Enrollment ID: I20190110000060 |
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