| Ab Boutique Medicine Llc | |
|
20 E Thomas Rd Ste 2200 Phoenix AZ 85012-3133 | |
| (512) 203-0413 | |
| Not Available |
| Full Name | Ab Boutique Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 20 E Thomas Rd Ste 2200, Phoenix, Arizona |
| Authorized Official Name and Position | Chad Benninghoff (OWNER) |
| Authorized Official Contact | 5122030413 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ab Boutique Medicine Llc 20 E Thomas Rd Ste 2200 Phoenix AZ 85012-3133 Ph: (512) 203-0413 | Ab Boutique Medicine Llc 20 E Thomas Rd Ste 2200 Phoenix AZ 85012-3133 Ph: (512) 203-0413 |
| NPI Number | 1285414888 |
|---|---|
| Provider Enumeration Date | 10/02/2023 |
| Last Update Date | 10/02/2023 |
| Medicare PECOS PAC ID | 5698122786 |
|---|---|
| Medicare Enrollment ID | O20231110002300 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285414888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Chad Benninghoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912256256 PECOS PAC ID: 4385894203 Enrollment ID: I20151209001141 |
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