| Southwest Center | |
|
1101 N. Central Avenue Suite 200 Phoenix AZ 85004 | |
| (602) 307-5330 | |
| (602) 307-5021 |
| Full Name | Southwest Center |
|---|---|
| Speciality | Registered Nurse |
| Location | 1101 N. Central Avenue, Phoenix, Arizona |
| Authorized Official Name and Position | Martha Acpsta (CREDENTIALING MANAGER) |
| Authorized Official Contact | 6025958109 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Center 1101 N Central Ave Ste 200 Phoenix AZ 85004-1844 Ph: (602) 347-0873 | Southwest Center 1101 N. Central Avenue Suite 200 Phoenix AZ 85004 Ph: (602) 307-5330 |
| NPI Number | 1104929504 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 07/06/2020 |
| Certification Date | 07/06/2020 |
| Medicare PECOS PAC ID | 3678518016 |
|---|---|
| Medicare Enrollment ID | O20050625000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104929504 | NPI | - | NPPES |
| 1144851205 | Medicaid | AZ | |
| 928418 | Medicaid | AZ |
| Provider Name | Kathleen A Smerko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366453029 PECOS PAC ID: 7214994359 Enrollment ID: I20041210000217 |
| Provider Name | Melissa Leigh Suchon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538573225 PECOS PAC ID: 7012138142 Enrollment ID: I20141014002351 |
| Provider Name | Faith M Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437448859 PECOS PAC ID: 3072735166 Enrollment ID: I20141104002716 |
| Provider Name | Maria Antonieta Andrews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801196175 PECOS PAC ID: 0941587786 Enrollment ID: I20170504002064 |
| Provider Name | Joy Golden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104363183 PECOS PAC ID: 4486931730 Enrollment ID: I20170515001912 |
| Provider Name | Caryn J Chisholm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922522275 PECOS PAC ID: 2668738295 Enrollment ID: I20171114002368 |
| Provider Name | Paul M Hardt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205313798 PECOS PAC ID: 9931445699 Enrollment ID: I20190116004004 |
| Provider Name | Leanne J Muniz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326510389 PECOS PAC ID: 6305189499 Enrollment ID: I20190513000551 |
| Provider Name | Vickie Renee Mcpherson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376954818 PECOS PAC ID: 2365782356 Enrollment ID: I20191114002752 |
| Provider Name | Chelsea D Ryan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093194532 PECOS PAC ID: 4082040795 Enrollment ID: I20200128002080 |
| Provider Name | James T Ballentine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477708071 PECOS PAC ID: 1759717473 Enrollment ID: I20200128002805 |
| Provider Name | Josue Bustos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003466731 PECOS PAC ID: 3971934936 Enrollment ID: I20200507002803 |
| Provider Name | Taylor R Piontek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912554817 PECOS PAC ID: 7517385875 Enrollment ID: I20200914002879 |
| Provider Name | Breenecia Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306324769 PECOS PAC ID: 9436559614 Enrollment ID: I20210609001378 |
| Provider Name | Lea Nickolas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306471644 PECOS PAC ID: 8224435268 Enrollment ID: I20210917002349 |
| Provider Name | Heather Renae Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548900921 PECOS PAC ID: 0749668085 Enrollment ID: I20220527001430 |
| Provider Name | Nicholas Conrad Eisemann-astone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114633815 PECOS PAC ID: 2365815297 Enrollment ID: I20230223002722 |
| Provider Name | Britta K Lane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508552670 PECOS PAC ID: 2163887845 Enrollment ID: I20230502002567 |
| Provider Name | Raven Deneice Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023718590 PECOS PAC ID: 7113382664 Enrollment ID: I20230505000316 |
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