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18527 W Ewers Dr Surprise AZ 85374-3917 | |
| (623) 377-8397 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 18527 W Ewers Dr, Surprise, Arizona |
| Authorized Official Name and Position | Jennifer Keiser (OWNER) |
| Authorized Official Contact | 6233778397 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
15411 W Waddell Rd Ste 102 Surprise AZ 85379-5170 Ph: (623) 377-8397 | 18527 W Ewers Dr Surprise AZ 85374-3917 Ph: (623) 377-8397 |
| NPI Number | 1417775446 |
|---|---|
| Provider Enumeration Date | 09/30/2024 |
| Last Update Date | 10/30/2024 |
| Certification Date | 10/30/2024 |
| Medicare PECOS PAC ID | 0143755322 |
|---|---|
| Medicare Enrollment ID | O20241125002615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417775446 | NPI | - | NPPES |
| 1861692741 | Other | AZ | NPI JENNIFER KEISER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jennifer Anne Keiser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861692741 PECOS PAC ID: 2860927043 Enrollment ID: I20241125002789 |
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