| |
440 North Navajo Drive Page AZ 86040-1625 | |
(928) 645-1700 | |
(928) 645-1701 |
Full Name | |
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Speciality | Clinic/Center |
Location | 440 North Navajo Drive, Page, Arizona |
Authorized Official Name and Position | Elizabeth G Latham (CEO) |
Authorized Official Contact | 9286459675 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1625 Page AZ 86040-1625 Ph: (928) 645-9675 | 440 North Navajo Drive Page AZ 86040-1625 Ph: (928) 645-1700 |
NPI Number | 1669441564 |
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Provider Enumeration Date | 03/15/2006 |
Last Update Date | 09/23/2021 |
Medicare PECOS PAC ID | 4082509591 |
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Medicare Enrollment ID | O20070213000663 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669441564 | NPI | - | NPPES |
432857 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QC1500X | Clinic/center - Community Health | OTC 3854 - DOH (Arizona) | Primary |
Banner Hospital Based Physicians Arizona Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 N Navajo, Page, AZ 86040 Phone: 928-645-0112 | |
Banner Physician Specialists Arizona Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 N Navajo, Page, AZ 86040 Phone: 928-645-0131 Fax: 928-645-3549 | |
Banner - University Physician Specialists Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 N Navajo Dr, Page, AZ 86040 Phone: 928-645-0131 Fax: 928-645-3549 | |
Canyonlands Community Health Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 635 Elm Street, #9, Page, AZ 86040 Phone: 928-645-8864 |