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1000 Ainsworth Dr Ste B215 Prescott AZ 86305-3411 | |
| (928) 445-0744 | |
| (928) 447-9911 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1000 Ainsworth Dr Ste B215, Prescott, Arizona |
| Authorized Official Name and Position | Adam Francis Rogers (OWNER) |
| Authorized Official Contact | 9288301401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1000 Ainsworth Dr Ste B215 Prescott AZ 86305-3411 Ph: (928) 445-0744 | 1000 Ainsworth Dr Ste B215 Prescott AZ 86305-3411 Ph: (928) 445-0744 |
| NPI Number | 1659035137 |
|---|---|
| Provider Enumeration Date | 10/29/2021 |
| Last Update Date | 05/31/2024 |
| Certification Date | 05/31/2024 |
| Medicare PECOS PAC ID | 9234525395 |
|---|---|
| Medicare Enrollment ID | O20220330000567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659035137 | NPI | - | NPPES |
| Provider Name | John S Gilliam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003877085 PECOS PAC ID: 7618989831 Enrollment ID: I20110509000734 |
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