| Black Diamond Medical Llc | |
|
20449 N Lake Pleasant Rd Ste 101 Peoria AZ 85382-2707 | |
| (623) 322-0099 | |
| Not Available |
| Full Name | Black Diamond Medical Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 20449 N Lake Pleasant Rd Ste 101, Peoria, Arizona |
| Authorized Official Name and Position | Tonia Lanette Graham (CO-OWNER) |
| Authorized Official Contact | 6233220099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Diamond Medical Llc 20449 N Lake Pleasant Rd Ste 101 Peoria AZ 85382-2707 Ph: (623) 322-0099 | Black Diamond Medical Llc 20449 N Lake Pleasant Rd Ste 101 Peoria AZ 85382-2707 Ph: (623) 322-0099 |
| NPI Number | 1639644909 |
|---|---|
| Provider Enumeration Date | 10/12/2018 |
| Last Update Date | 03/06/2020 |
| Medicare PECOS PAC ID | 4688911811 |
|---|---|
| Medicare Enrollment ID | O20190125003095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639644909 | NPI | - | NPPES |
| Provider Name | Tonia L Graham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699108621 PECOS PAC ID: 9133354319 Enrollment ID: I20131023001831 |
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