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15317 W Bell Rd Surprise AZ 85374-3877 | |
(480) 964-2273 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 15317 W Bell Rd, Surprise, Arizona |
Authorized Official Name and Position | Krystal Powell (REVENUE CYCLE DIRECTOR) |
Authorized Official Contact | 6235833001 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3033 N Central Ave Ste 145 Phoenix AZ 85012-2808 Ph: () - | 15317 W Bell Rd Surprise AZ 85374-3877 Ph: (480) 964-2273 |
NPI Number | 1407132673 |
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Provider Enumeration Date | 11/01/2011 |
Last Update Date | 04/28/2023 |
Medicare PECOS PAC ID | 4688588643 |
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Medicare Enrollment ID | O20221004001001 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407132673 | NPI | - | NPPES |
311161 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | Y005422 (Arizona) | Primary |
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