| |
12851 W Bell Rd Ste 118 Surprise AZ 85378-9609 | |
(623) 584-9279 | |
(855) 978-1884 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 12851 W Bell Rd Ste 118, Surprise, Arizona |
Authorized Official Name and Position | Jane M Abucha (CEO) |
Authorized Official Contact | 6235849279 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1543 Sun City AZ 85372-1543 Ph: (623) 584-9279 | 12851 W Bell Rd Ste 118 Surprise AZ 85378-9609 Ph: (623) 584-9279 |
NPI Number | 1417629445 |
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Provider Enumeration Date | 09/28/2021 |
Last Update Date | 12/28/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417629445 | NPI | - | NPPES |
796987 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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