| |
44031 E Plumosa Road Bouse AZ 85325 | |
(928) 669-8512 | |
(928) 851-1828 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 44031 E Plumosa Road, Bouse, Arizona |
Authorized Official Name and Position | Kevin Brown (CEO) |
Authorized Official Contact | 9286697300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1200 W Mohave Rd Parker AZ 85344-6349 Ph: (928) 669-9201 | 44031 E Plumosa Road Bouse AZ 85325 Ph: (928) 669-8512 |
NPI Number | 1235154147 |
---|---|
Provider Enumeration Date | 07/12/2006 |
Last Update Date | 06/06/2017 |
Medicare PECOS PAC ID | 1557273356 |
---|---|
Medicare Enrollment ID | O20080618000378 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235154147 | NPI | - | NPPES |
CG7880 | Other | AZ | MEDICARE RR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |