| Avista Medical Center & Weight Loss | |
|
690 E Warner Rd Ste 133 Gilbert AZ 85296-3057 | |
| (480) 892-1212 | |
| (480) 892-4941 |
| Full Name | Avista Medical Center & Weight Loss |
|---|---|
| Speciality | Family Medicine |
| Location | 690 E Warner Rd Ste 133, Gilbert, Arizona |
| Authorized Official Name and Position | Chad Gammage (CEO) |
| Authorized Official Contact | 4808921212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avista Medical Center & Weight Loss 690 E Warner Rd Ste 133 Gilbert AZ 85296-3057 Ph: (480) 892-1212 | Avista Medical Center & Weight Loss 690 E Warner Rd Ste 133 Gilbert AZ 85296-3057 Ph: (480) 892-1212 |
| NPI Number | 1073807202 |
|---|---|
| Provider Enumeration Date | 06/06/2011 |
| Last Update Date | 02/08/2022 |
| Medicare PECOS PAC ID | 2668643743 |
|---|---|
| Medicare Enrollment ID | O20110921000417 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073807202 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 28418 (Arizona) | Primary |
| Provider Name | Punya K Raman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215907209 PECOS PAC ID: 7012009046 Enrollment ID: I20070822001280 |
| Provider Name | Shannon Lynn Stark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730645763 PECOS PAC ID: 8123369212 Enrollment ID: I20190418001998 |
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