| |
24656 North Lake Pleasant Parkway St 103-288 Peoria AZ 85373 | |
(602) 697-1147 | |
(602) 391-2234 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 24656 North Lake Pleasant Parkway, Peoria, Arizona |
Authorized Official Name and Position | Barbara Story Williams (OWNER) |
Authorized Official Contact | 6026971147 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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24656 North Lake Pleasant Parkway St 103-288 Peoria AZ 85373 Ph: (602) 697-1147 | 24656 North Lake Pleasant Parkway St 103-288 Peoria AZ 85373 Ph: (602) 697-1147 |
NPI Number | 1427419894 |
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Provider Enumeration Date | 03/14/2016 |
Last Update Date | 03/14/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427419894 | NPI | - | NPPES |
Z177987 | Other | AZ | PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | AP7842 (Arizona) | Primary |
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