| Active Vital Care Llc | |
|
2375 E Camelback Rd Ste 600 Phoenix AZ 85016-3493 | |
| (833) 242-0100 | |
| (623) 889-0814 |
| Full Name | Active Vital Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2375 E Camelback Rd Ste 600, Phoenix, Arizona |
| Authorized Official Name and Position | Drew Sturgis (OWNER) |
| Authorized Official Contact | 6233770186 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Vital Care Llc 2375 E Camelback Rd Ste 600 Phoenix AZ 85016-3493 Ph: (833) 242-0100 | Active Vital Care Llc 2375 E Camelback Rd Ste 600 Phoenix AZ 85016-3493 Ph: (833) 242-0100 |
| NPI Number | 1326825092 |
|---|---|
| Provider Enumeration Date | 09/14/2023 |
| Last Update Date | 11/02/2023 |
| Medicare PECOS PAC ID | 3870942428 |
|---|---|
| Medicare Enrollment ID | O20231208000557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326825092 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard A Wall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811971393 PECOS PAC ID: 9638211329 Enrollment ID: I20100119000165 |
| Provider Name | Bradley Hughes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821318262 PECOS PAC ID: 7618291014 Enrollment ID: I20150113000383 |
| Provider Name | Kevin S. Broaddrick |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1639188394 PECOS PAC ID: 1951393867 Enrollment ID: I20150723007902 |
| Provider Name | Dien T Do |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609326289 PECOS PAC ID: 9830477256 Enrollment ID: I20161104001524 |
| Provider Name | Daniel Douglas Kiddy |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1144214529 PECOS PAC ID: 2567414030 Enrollment ID: I20180628002708 |
| Provider Name | David A Rand |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396923264 PECOS PAC ID: 1456602465 Enrollment ID: I20181001001122 |
| Provider Name | James Warren Reznick |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1659376689 PECOS PAC ID: 7911187174 Enrollment ID: I20190226000587 |
| Provider Name | Rebecca L Schoenherr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255582359 PECOS PAC ID: 7517014186 Enrollment ID: I20190228000869 |
| Provider Name | Maria Kojs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952915449 PECOS PAC ID: 9234559824 Enrollment ID: I20201021000197 |
| Provider Name | Carlos Dv Montes Domini |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1528043429 PECOS PAC ID: 0840193355 Enrollment ID: I20220202002428 |
| Provider Name | Kristen N Murray |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1528346145 PECOS PAC ID: 8729306121 Enrollment ID: I20220309002735 |
| Provider Name | Jonathan Robert Martens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184335085 PECOS PAC ID: 0547625824 Enrollment ID: I20230421000587 |
| Provider Name | Scott Adam Gregorowicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023844388 PECOS PAC ID: 3476085036 Enrollment ID: I20241021002238 |
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