| Black Mountain Family Medicine | |
|
33755 N Scottsdale Rd Suite 120 Scottsdale AZ 85266-1567 | |
| (480) 595-8900 | |
| (480) 595-8910 |
| Full Name | Black Mountain Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 33755 N Scottsdale Rd, Scottsdale, Arizona |
| Authorized Official Name and Position | John Bickle (PRESIDENT) |
| Authorized Official Contact | 4805958900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Mountain Family Medicine 33755 N Scottsdale Rd Suite 120 Scottsdale AZ 85266-1567 Ph: (480) 595-8900 | Black Mountain Family Medicine 33755 N Scottsdale Rd Suite 120 Scottsdale AZ 85266-1567 Ph: (480) 595-8900 |
| NPI Number | 1861522419 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 05/19/2008 |
| Medicare PECOS PAC ID | 8729187315 |
|---|---|
| Medicare Enrollment ID | O20070622000076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861522419 | NPI | - | NPPES |
| AZ0714850 | Other | AZ | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 30905 (Arizona) | Primary |
| Provider Name | John S Bickle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134136591 PECOS PAC ID: 4789601329 Enrollment ID: I20051102000102 |
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