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26750 S. Santa Fe Road Suite B Congress AZ 85332 | |
(928) 668-1813 | |
(928) 668-1844 |
Full Name | |
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Speciality | Clinic/Center |
Location | 26750 S. Santa Fe Road, Congress, Arizona |
Authorized Official Name and Position | James Tavary (PRESIDENT & CEO) |
Authorized Official Contact | 9286845421 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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520 Rose Ln Wickenburg AZ 85390-1447 Ph: (928) 684-5421 | 26750 S. Santa Fe Road Suite B Congress AZ 85332 Ph: (928) 668-1813 |
NPI Number | 1609144393 |
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Provider Enumeration Date | 12/08/2011 |
Last Update Date | 05/10/2019 |
Medicare PECOS PAC ID | 4981688900 |
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Medicare Enrollment ID | O20120404000398 |
Identifier | Type | State | Issuer |
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1609144393 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |