| Cchci Seabhs Clinic | |
|
4755 Campus Dr Sierra Vista AZ 85635-2449 | |
| (520) 459-3011 | |
| (520) 364-4261 |
| Full Name | Cchci Seabhs Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 4755 Campus Dr, Sierra Vista, Arizona |
| Authorized Official Name and Position | Jonathan P Melk (CEO) |
| Authorized Official Contact | 5203646852 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cchci Seabhs Clinic 1205 F Ave Douglas AZ 85607-1920 Ph: (520) 364-6852 | Cchci Seabhs Clinic 4755 Campus Dr Sierra Vista AZ 85635-2449 Ph: (520) 459-3011 |
| NPI Number | 1487175162 |
|---|---|
| Provider Enumeration Date | 07/03/2017 |
| Last Update Date | 09/01/2021 |
| Medicare PECOS PAC ID | 5395638878 |
|---|---|
| Medicare Enrollment ID | O20180205000641 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487175162 | NPI | - | NPPES |
| 275274 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | OTC8372 (Arizona) | Primary |
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