| Arizona Clinic Pllc | |
|
4834 E Broadway Blvd Tucson AZ 85711-3610 | |
| (206) 551-0154 | |
| (702) 441-1961 |
| Full Name | Arizona Clinic Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 4834 E Broadway Blvd, Tucson, Arizona |
| Authorized Official Name and Position | Michael Minckler (CEO) |
| Authorized Official Contact | 2065510154 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arizona Clinic Pllc 4834 E Broadway Blvd Tucson AZ 85711-3610 Ph: (206) 551-0154 | Arizona Clinic Pllc 4834 E Broadway Blvd Tucson AZ 85711-3610 Ph: (206) 551-0154 |
| NPI Number | 1053188771 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 12/04/2023 |
| Medicare PECOS PAC ID | 2961852462 |
|---|---|
| Medicare Enrollment ID | O20231226000891 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053188771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael R Minckler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821437484 PECOS PAC ID: 1557669785 Enrollment ID: I20160420002461 |
| Provider Name | Mark Thomas Bernardi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073900536 PECOS PAC ID: 3476818667 Enrollment ID: I20191111001922 |
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